Susan's Place Transgender Resources

In some recent posts I've noticed quite a few references to Gatekeeping, almost always in negative contexts.

My understanding of the definition of Gatekeeping is: Health care providers who intentionally withhold treatment or recommendations that facilitate the progression of transition from Transgender patients  based on non-clinical, unprofessional bias.

I read this as: Doctors or therapists with personal issues with Transgender patients, where those issues directly interfere with or contradict established Standards of Care.

I see this as a very separate and specific issue with individual providers that should not be confused or lumped in with the fact that Standards of Care exist, and for good reason.

For every "Well, I never needed to talk to anyone about my feelings and self-medicated my way to happiness!" there are likely five times the number of people who directly benefited from a measured, paced, and medically monitored transition.   

I am happy for people that are happy, as we all should be I hope, and there is absolutely a "regardless of how you got there" component to that.

Where that breaks down for me is when folks who have successfully gone from point A to point B in their lives, specifically without the use of therapy or medical supervision, label all activities that do fall within a Standards of Care structure as "Gatekeeping" and unnecessary.  There is danger there in the codified dismissal of transitioning under supervision in my opinion, especially in a place where a great many are here seeking definitions and contexts to embrace, often for the first time.

If a medical or mental health provider is exhibiting bias that is obstructionist and unprofessional, report them and then find another provider.

I feel pretty strongly that labeling all medical and mental health interactions that may comprise a Standard of Care as "Gatekeeping" is an intentional political misnomer steeped in a "I did it, so of course it applies to everyone!" posture often combined with a "No-one has the right to tell me what to do!" self-entitled arrogance.

"YMMV" gets tossed around a lot, and I feel that there are fewer things that are more personal or more subjective to any individual than going through a transition.  The level of sharing here is appreciated even more in light of that, right up until "YMMV" somehow turns into "ONE SIZE FITS ALL."  Any gross simplification of complex mechanisms feels amazingly dangerous when health and well-being are the focus.

Being aware of labeling, broad brush strokes and oversimplified generalizations based on agendas, and an awareness of avoiding such things makes it easier to distinguish opinion based on specific personal experience and opinions that are disingenuously presented as iron-clad facts to further a single, agenda-driven perspective.

Semantics and context both matter in hugely significant ways in environments like this where all we have to interpret is the written word.  It is not my intent to start a flame war here, nor judge or disparage anyone's personal path or the choices they have made.

I am talking about how information is presented and communicated and how best to maintain some measure of objectivity in the terminology we use and share.

-Miki

Quote from: Miki on April 11, 2012, 10:39:01 AM
In some recent posts I've noticed quite a few references to Gatekeeping, almost always in negative contexts.

My understanding of the definition of Gatekeeping is: Health care providers who intentionally withhold treatment or recommendations that facilitate the progression of transition from Transgender patients  based on non-clinical, unprofessional bias.

I read this as: Doctors or therapists with personal issues with Transgender patients, where those issues directly interfere with or contradict established Standards of Care.

You have successfully highlighted U.K NHS GIC system!

Do I hate it, YES.

But I still have a head on my shoulders and understand it's necessary.
Some people aren't responsible enough to fully understand all the consequences,
and need a professional to guide them through and assure it's right for them.

It would be selfish of me to be against it. It's not because I feel I don't need it, that it's the case for everyone.
I have to keep in mind all the people that are going to be helped through it.

Quote from: Jayr on April 11, 2012, 11:45:02 AM
It would be selfish of me to be against it. It's not because I feel I don't need it, that it's the case for everyone.
I have to keep in mind all the people that are going to be helped through it.

Helped through it? Gatekeepers or GIC psych's etc acted as brick walls in front of my progress and promoted negativity and caused me severe depression. The only person who helped me through it is me! by getting the hell out of that whole dreadful system!

Quote from: Naturally Blonde on April 11, 2012, 12:18:40 PM
Helped through it? Gatekeepers or GIC psych's etc acted as brick walls in front of my progress and promoted negativity and caused me severe depression. The only person who helped me through it is me! by getting the hell out of that whole dreadful system!

I guess Jay should have put a disclaimer in his message.
There shouldn't have had been one on Jay's post, but I'll add one now.

CAUTION: Everyone is different and certain people don't need guidance. Yes, Naturally Blonde, that means you. Condragulations.

Quote from: Naturally Blonde on April 11, 2012, 12:18:40 PM
Helped through it? Gatekeepers or GIC psych's etc acted as brick walls in front of my progress and promoted negativity and caused me severe depression. The only person who helped me through it is me! by getting the hell out of that whole dreadful system!

I'm sorry that was your personal experience and I am glad you've come out the other side of it successfully.  :)



My point was that "Gatekeeping" is a verb.  A specific activity that is engaged in with the intent to block or inhibit transition.  It is something that is done, not something that is.

It is absolutely not a catch-all proper name for any process under any Standards of Care that espouses counseling, therapy and proper medical supervision.

-Miki

 It is my opinion that gatekeeping should be reduced, as opposed to eliminated. I'm greatly in favour of informed-consent options for hormones, due to their gradual and diagnostic natures, and think that the wait times on other things are too long.

The real life test period, for example, should be a half-year long. Most people will figure out that transition is not right for them by that point, and for those who know they need SRS, then it makes little difference aside from letting them get on with their lives sooner.

There should be some gate-keeping on FFS - in the form of real life experience requirements. Let's say six months, like for SRS. FFS is major surgery, and can be just as life-changing as SRS if not moreso.

:) My thoughts.

Personally, I don't really appreciate the gate-keeping thing at all. However, I realize that many people find it extremely useful; at the very minimum, though, I would suggest there always be a three-month RLE for surgery. It's big stuff...

From my own personal experiences of 'Gatekeeping' it almost ruined my life and it's horrendous that a complete stranger you don't really know can makes decisions on your life. I can't hide my personal disgust and hatred for them.

Thank god I moved on with my life and far away from the GIC system...

I considered my therapist one of the most wonderful people in my life. Not only did she help me through some rough times at first but she really gave me sound, wise, and sage advice.

She helped me put things into perspective. She helped me get over the issue that I could transition before Seminary. She helped me gather the courage to face my family for the very first time.

She had made such an impact to me, she's been invited to my graduation, my ordination and other important events in my life.

Some people hate gatekeeping and gatekeepers. I, on the other hand, benefited greatly from it and if I had to do it all over again, I would do the same exact thing.

Annah

In theory, the gatekeepers do have access to a somewhat objective feedback measure.

If the proportion of patients they see who are already self medicating exceeds a certain threshold then they know their practices are not fit for purpose and do not serve the people they're supposed to help.

You could argue that it's become too easy to self-med these days, but I'd say everyone who does self-med would prefer reasonable access to the safer method of treatment that the gatekeepers provide.

I feel that the therapist I've been working with has been tremendously helpful to me. Also, I don't mind the idea of getting a physical and having lab tests before seeing the endocrinologist to start HRT.

A full year of RLE seems a bit much, to me. But, it's what I'm doing. I understand the reasons behind this time frame, so I've accepted it.

Quote from: Annah on April 11, 2012, 01:22:57 PM
I considered my therapist one of the most wonderful people in my life. Not only did she help me through some rough times at first but she really gave me sound, wise, and sage advice.

She helped me put things into perspective. She helped me get over the issue that I could transition before Seminary. She helped me gather the courage to face my family for the very first time.

She had made such an impact to me, she's been invited to my graduation, my ordination and other important events in my life.

Some people hate gatekeeping and gatekeepers. I, on the other hand, benefited greatly from it and if I had to do it all over again, I would do the same exact thing.

Annah

In the United Kingdom the NHS GIC run system is a million miles away from the type of system you have in America.  Over here in the U.K we have psychiatrists not therapists and we don't have therapy just an aggressive psychiatrist grilling our every word,often to the point of interrogation.  Our private system is so much better than the NHS system and my experiences with a private psychiatrist were very different to my NHS experiences.

I imagine if I lived in America I wouldn't have had the same experiences I've had in England.

Quote from: Naturally Blonde on April 11, 2012, 03:10:14 PM
In the United Kingdom the NHS GIC run system is a million miles away from the type of system you have in America.  Over here in the U.K we have psychiatrists not therapists and we don't have therapy just an aggressive psychiatrist grilling our every word,often to the point of interrogation.  Our private system is so much better than the NHS system and my experiences with a private psychiatrist were very different to my NHS experiences.

So far my NHS experiences have been totally different from yours. I do not know why yours was so bad but so far I have had nothing but support from the NHS.

Quote from: Naturally Blonde on April 11, 2012, 03:10:14 PM
I imagine if I lived in America I wouldn't have had the same experiences I've had in England.

I agree. You could have the persecution that small minded bigots seem to enjoy showering on our US friends, including lots of discrimintaion, laws to force you to use the wrong toilets, the ability to sack you from your job for nothing other than being trans and to cap it all off you have to pay huge amounts of money for the privilege of being treated like that.

The US women on here repeatedly prove that things do not get better just because you have to pay for it yourself. They get bad gatekeepers / therapists / SRS just like we do.

Let's stick to talking about our personal experience please, and not universalising it - clearly, many individuals here on Susan's have had very, very different experiences of going through the SoC system in each country where it's applied - partly because it's being applied by different healthcare professionals (some with very different agendas, it would seem), partly because different rules (and funding policies) apply in different areas, and partly because we, the clients, are all very different, with very diverse needs.

Quote from: Beverley on April 11, 2012, 03:22:46 PM

The US women on here repeatedly prove that things do not get better just because you have to pay for it yourself. They get bad gatekeepers / therapists / SRS just like we do.

I've always paid for everything myself and never received any help from the NHS. Over here in the U.K private treatment is a lot better and more humane.

I hope Padma doesn't mind my contribution here. I don't intend to start a transatlantic war, I do think there are some issues that have not been covered.



There are tow essential effects of the current system.

Firstly, that it makes the Dr liable for agreeing to our requests.

Secondly, that it removes from us, responsibility for our actions.

The only medical criteria is that I should be capable of surviving the procedure.

If I choose to got through counciling before hand, that is my choice.

My therapist was basically a rubber stamp for me. He saw me for a couple months, wrote a letter and told me to talk to a certain endo. The waiting list for this endo was so long, he didn't even contact me after a year. I started self medicating and looked for my own doctor and found one. He wrote another letter and faxed her. After a few months of seeing my doctor, she wanted me to see my therapist again. I went to him yesterday and he told me he would write a letter to my school recommending I start RLE there, and a write off for an orchiectomy.

I'm just glad I haven't had a therapist get in my way. Since I've been on hormones I've never been happier, especially when I'm out doing RLE. It's gotten to the point where I am disgusted with myself when I have to present male (at work).

I wonder if  the cheerleaders for  gate keeping would feel the way they do if their therapist had been clueless, had bad advice and they felt forced to continue sessions anyway just so they could get a letter to get on HRT, after living full time for several years already and knowing what they wanted.

I'm glad this gate keeping made them go in search of the help THEY needed. They keep assuming everyone needs a therapist to understand who they are and what they want. This same thing they feel blessed over, what a royal PITA for me. And I'm not done given I will need to be subjected to more therapy if/when I go for GRS.

Quote from: spacial on April 11, 2012, 04:15:18 PM
There are tow essential effects of the current system.

Firstly, that it makes the Dr liable for agreeing to our requests.

Secondly, that it removes from us, responsibility for our actions.

Exactly how I feel..

Quote from: Stephe on April 11, 2012, 05:18:10 PM

I wonder if  the cheerleaders for  gate keeping would feel the way they do if their therapist had been clueless, had bad advice and they felt forced to continue sessions anyway just so they could get a letter to get on HRT, after living full time for several years already and knowing what they wanted.

I'm glad this gate keeping made them go in search of the help THEY needed. They keep assuming everyone needs a therapist to understand who they are and what they want. This same thing they feel blessed over, what a royal PITA for me. And I'm not done given I will need to be subjected to more therapy if/when I go for GRS.

My first one was inadequate so I fired him. Got another therapist who was confidant. If they give bad advice or seem to not know what they are doing they I look around. I didn't sit around and mope and cry when i had a bad therapist. I was proactive and found another.

I found my therapist in Florida. I lived in Maryland at the time so I refuse to let distance stop my transition.

I find it a little assanizing that you use the word "cheerleader" for anyone who assumes therapy can be a good tool to help others. Exercise a little mutual respect for others who do see a therapist and enjoyed it and stop trolling anyone who differs in opinion than you. I still haven't forgotten how you accused me of taking money from the homeless people because my church helped me financially through my medical transition. So, sorry, if I don't take your attacks seriously.

I'm not cheerleading for the gatekeeping process. I followed it because it was my understanding that it could be the best way to achieve my goals. I certainly didn't need a therapist to tell me that I'm trans. But getting the letter from her certainly helped.

And if that therapist had been clueless or anti-trans, I would have chosen another. I chose this particular therapist as she was listed in the BlueShield database as one who works the LGBT clients.

Quote from: Connie Anne on April 11, 2012, 06:04:06 PM
I'm not cheerleading for the gatekeeping process. I followed it because it was my understanding that it could be the best way to achieve my goals. I certainly didn't need a therapist to tell me that I'm trans. But getting the letter from her certainly helped.

And if that therapist had been clueless or anti-trans, I would have chosen another. I chose this particular therapist as she was listed in the BlueShield database as one who works the LGBT clients.

Some people assume that if you do not mind the gateway process then you're a tool and you cannot effectively manage how a therapist treats you. In my opinion, that's just an unproductive stereotype that does utterly nothing but divide people. When people call those who enjoyed their therapy experience as cheerleaders, you can only shake your head and feel sorry for them for being so narrow minded.

 Some people are so aggressive...

I didn't find my gatekeeping experience very positive or helpful, but if my therapists/doctors were competent, I may have found it helpful. I will still say, though, that gatekeeping should be reduced overall, mostly just for hormone access, as while gate-keepers can be helpful, they often waste valuable time that an individual spends becoming more masculine, depressed, and etcetera. I spend a lot of time with the younger crowd, where the effects are most devastating, and that's my basis.

And the best thing about being where I live... you don't have any choice in who keeps your gates. :)

Quote from: Annah on April 11, 2012, 06:08:15 PM
Some people assume that if you do not mind the gateway process then you're a tool and you cannot effectively manage how a therapist treats you. In my opinion, that's just an unproductive stereotype that does utterly nothing but divide people. When people call those who enjoyed their therapy experience as cheerleaders, you can only shake your head and feel sorry for them for being so narrow minded.

That's not how I would have worded it, but I can see how some might come to that conclusion.

I find it fascinating that the entire point of my OP is being missed by folks who insist on defining and viewing "Gatekeeping" as any process that involves therapy or a Doctor and lump any adherence to Standards of Care into a single category.

There are a lot of gray areas here, and my point was that by avoiding blanket labels and not stating personal experience and opinions as facts that universally apply to everyone, folks reading can more easily distinguish the difference between helpful, objective statements and angst-ridden, agenda-driven bull->-bleeped-<- pulled out of someone's ass.

People who insist on playing the 6 Degrees of Self-Serving Rationalization Game™ are beating wardrums and intentionally painting with the broadest brush possible in order to be right at the expense of being accurate, objective or helpful.

You can play that game with anything, and it always, without fail, looks stupid at the end:

"I once ate a red jelly bean, then I got sick."

"OMG, red jelly beans make you sick!"

"Jelly beans are dangerous!"

"We all know that oval shaped candies are dangerous!"

"Obviously, all those candy supporters want you to be sick!"

"Brachs is involved in a world-wide conspiracy, everyone knows that!"




Ridiculous yammering is ridiculous.

-Miki

So, why stop with what they have? Why are we in such need of "protecting"?

How about before you can by fast-food they will run health tests on you to make sure you aren't obese and doing further damage to your body?

How about they make you see a therapist before buying alcohol (many people use alcohol as crutches to deal with serious issues in their lives, this is for their own good... sure, not everyone has this problem, but better safe than sorry right?).

How about others force their way into EVERY aspect of your life to double check your choices and make sure you are doing it for the right reasons and understand the consequences?

The rest of the world gets to make their own choices for their body... but transgendered people are OBVIOUSLY nuts, so it is ok if we just make sure? Cool beans.

Perhaps because buying and eating a Big Mac and being disappointed in how the special sauce tastes after the fact hasn't ever led to someone killing themselves.  Drinking a beer hasn't, to my knowledge, removed genitals as a result.

In a perfect world, where there are no such things as liability, tort law, malpractice and ambulance chasing lawyers, you should have the right to determine your own path unhindered and unquestioned.  That would be amazing.  Even then, making medical decisions in a vacuum would be dangerous.  Are you qualified to check for liver issues?  Monitor the effects of HRT on your system?  Going to perform your own surgery?  Ah, right, you require others to facilitate your transition. 

What if you signed a waiver, would that be ethical then?  "If I die, it's my own damn fault because how dare anyone tell me ->-bleeped-<-."   I'd buy into that.  That's just natural selection in motion at that point. 

There is a huge difference between feeling like you have to justify yourself in order to receive the care you need, and participating in a process that allows you to receive that care in a safe, structured fashion.  How many people misinterpret other issues as GID?  How many of those people would have rushed ahead on impulse and made irreversible medical decisions if there was absolutely no check and balance mechanism in place?

Having an SoC structure in place saves lives.  Railing against it as some greater manifestation of being controlled in your life is broad-brushing in the extreme in my opinion. 

If after that beer or that Big Mac, I decide for myself I don't like either, I can choose not to partake with zero consequences. 

The same cannot in any way, shape or form be said of transitioning from one gender to another.

-Miki

Quote from: Miki on April 11, 2012, 08:01:10 PM
Are you qualified to check for liver issues?

Nope but you don't have to have a psychotherapists approval to have it checked either.

The again I forget many people here believe being TG is "a mental disorder". Maybe that's why you feel it's OK to have all these special rules for us?

Quote from: Connie Anne on April 11, 2012, 06:04:06 PM
And if that therapist had been clueless or anti-trans, I would have chosen another. I chose this particular therapist as she was listed in the BlueShield database as one who works the LGBT clients.

My therapist was a post-op MTF TS. Hard to say why she was so clueless but I doubt she was anti-trans. Maybe she just enjoyed the role of being the gatekeeper?

Or maybe it was just the fact I didn't need any therapy and was forced to have it, so others who don't want to take responsibility for their own actions are "safe"?

Quote from: Miki on April 11, 2012, 08:01:10 PM
Perhaps because buying and eating a Big Mac and being disappointed in how the special sauce tastes after the fact hasn't ever led to someone killing themselves.  Drinking a beer hasn't, to my knowledge, removed genitals as a result.

You are right... they both simply kill you.

Sometimes slow. Sometimes fast (sometimes you take other people with you! like with drunk driving).

I want to be free to make my own choices. But, of course, society thinks I'm crazy because I'm trans... they think something is wrong with my brain... so obviously, I shouldn't be trusted to make my own choices. That is the ONLY reason these gatekeepers are in place...

This is a fascinating thread.

The only thing I really have to add, regarding the issue of choice, is this. Using fast food as a good example... a lot of people like having the choice right up until something happens that they don't like as a direct result of that choice. Then they look for someone to blame for it.

"I ate and ate and ate until it caused problems to my health but do I take ownership of that and deal with it? No, I sue the makers of the fast food for making it so damned tasty and not telling me how bad it could be for me if I ate and ate and ate."

Being transgendered may or may not be a mental disorder, that point has been argued and re-argued many times over, but whether it is or it isn't, there are some psychological issues that people may have which may also illicit symptoms such as body dysphoria and/or a desire to be the opposite gender that, when discussed with a mental health professional, come to light and are discovered to have nothing to do with being transgendered whatsoever. Perhaps deep-seated traumatic events in a person's past that, when worked through with said professional, lead to the person in question realising that they, in fact, don't want the procedures that they once thought they did.

And in light of surgical procedures that are irriversible, and which impact so greatly on so many aspects of a person's life, it's better to be safe than sorry, in my opinion.

Eliminate this process and who knows, it may reach a point where surgeons refuse to perform such procedures on the grounds that they don't want to get their asses sued by people who thought it was what they wanted and decided down the road that it wasn't, and since there's nothing they can do to put things back to how they were, they have to find someone to blame instead for not helping them figure out what the real issues were sooner.

I wouldn't call it gatekeeping, I'd call it a safeguard for the benefit of the individual.

^agreed!

Quote from: Stephe on April 11, 2012, 05:18:10 PM
I wonder if  the cheerleaders for  gate keeping would feel the way they do if their therapist had been clueless, had bad advice and they felt forced to continue sessions anyway just so they could get a letter to get on HRT, after living full time for several years already and knowing what they wanted.

Wow. I'm sure you'd like to know I had a horrible therapist experience. My first therapist, was gross, horribly stereotypical, and obviously did not know what he was doing. I went home crying, more confused then ever. So before you assume all the ''cheerleaders'' for gates keeping had it all good, think about it a little. And you know what I did with my old therapist? I fired him and never went back. Duh.

But it would be ignorant and selfish of me to be all against gates keeping just because I personally had a bad experience. I keep in mind all the people that need it, whom gates keeping has saved them from making a major mistake. I keep in mind that some people don't understand what they are doing, that they obsess over things and don't realize what is going on. Gates keeping is a way to assure everyone knows how serious the matter is. Not everyone is responsible enough to understand how serious transition is. They need someone to just stop them at some point and force them to think a bit.

I think anything that serious needs gates keeping. Better safe than sorry.

Quote from: Sephirah on April 11, 2012, 08:40:59 PM
I wouldn't call it gatekeeping, I'd call it a safeguard for the benefit of the individual.

Agree with you.

Quote from: Sephirah on April 11, 2012, 08:40:59 PM

"I ate and ate and ate until it caused problems to my health but do I take ownership of that and deal with it? No, I sue the makers of the fast food for making it so damned tasty and not telling me how bad it could be for me if I ate and ate and ate."

Does this happen? Has a fat guy sued and won against fastfood for making them fat?

This isn't a legal issue. If they say "you can do this surgery with the consent of the patient" ... then... well... that is what it is.

If they want to put in some safeguards to help protect. That is fine... a year of hormones needed before surgery? Sure.

But, needing a mental screening before you can make your own choices?

Everyone seems to think this is the only area where people have other issues which are influencing their choices.

How about having a child? People do that for ALLLLLL sorts of wacked out reasons. Because they are lonely, or want attention, or an entire host of other issues. It permanently can change your body, it is a very life-changing issue (not just for yourself, but your partner AND the child... 3 lives)... and yet, you are free to get pregnant if you want to without a therapist making sure you are ready. Or a year of "real life baby" experience where you walk around with a child under your arm.

Basically... are there crazy people in the world who do stuff for the wrong reasons? YUP!!!! LOTS!! Tons, all over, for everything you can imagine... from eating to comfort themselves... to doing drugs or drinking... or even buying an expensive car.

Why aren't we protecting any of the other nuts who commonly do stuff we KNOW nuts are doing? Why it is only trans people are special?

This isn't about legal issues... this isn't about protection... this is simply that society thinks we are crazy (more so than everyone else)... so we need to be handled carefully before they will treat us.

Quote from: Rabbit on April 11, 2012, 08:56:45 PM
Does this happen? Has a fat guy sued and won against fastfood for making them fat?

Actually, yes.

http://www.minyanville.com/businessmarkets/articles/obesity-tort-law-tort-class-action/10/29/2010/id/30852?page=full

And there were the lawsuits against the tobacco companies because smoking gave people cancer.

QuoteBut, needing a mental screening before you can make your own choices?

This is exactly the point. When dealing with an issue stemming from the brain of an individual, you have to be sure that they are your own choices, and not influenced by a state of mind caused by something else, such as depression. And that there is no other cause which can be dealt with without the need for a procedure from which there's no turning back.

QuoteHow about having a child? People do that for ALLLLLL sorts of wacked out reasons. Because they are lonely, or want attention, or an entire host of other issues. It permanently can change your body, it is a very life-changing issue (not just for yourself, but your partner AND the child... 3 lives)... and yet, you are free to get pregnant if you want to without a therapist making sure you are ready. Or a year of "real life baby" experience where you walk around with a child under your arm.

Actually I agree with you there, a similar approach to parenting wouldn't be a bad idea at all.

QuoteThis isn't about legal issues... this isn't about protection... this is simply that society thinks we are crazy (more so than everyone else)... so we need to be handled carefully before they will treat us.

I don't think it's about transgendered people being crazy or not, I think it's more that so many aspects of the human mind are not fully understood. I mean just look at how many debates are had here with regard to what being transgendered is or isn't, and that's from people dealing with it. And athough some professionals are out of their depth in dealing with the issues of transgendered people, that doesn't make the whole process inherently flawed.

 NO LOCKED DOORS!!! Err....and GATES TOO!!  :icon_help:

Quote from: Rabbit on April 11, 2012, 08:56:45 PM...

If they want to put in some safeguards to help protect. That is fine... a year of hormones needed before surgery? Sure.

But, needing a mental screening before you can make your own choices?

...

This makes more sense.  Now you're talking about a very specific facet of a process, not the entire thing as a whole.

I personally resented the feeling of having to "prove" to someone else's satisfaction, professional or not, that I was feeling what I was feeling.  It felt like I had to justify who I was and subject my understanding of myself to someone else's scrutiny and judgement.  I railed against it, initially.

When my therapist actually submitted a diagnosis, recently, she very intentionally communicated to me that GID was the only diagnosis she could determine, and that this was a good thing as it would make forward progress along my transition plan far, far easier.  The immediate sense of relief and involuntary validation that I felt when she told me that was confusing at first, then pretty damn reassuring.  I was not misinterpreting myself, I was not filling in the wrong blanks when identifying how I was feeling, I was not confusing one thing for another.  I was gratified that she was thorough enough to have run down a list of things that my presentation to her could have been, and discounted them all as not applicable to me.  In her words, "Now we can not be distracted and really focus on making your transition as successful as we can."  It is kind of hard for me to resent that.

The fact that I felt better about it after the fact doesn't mean my initial resentment was misplaced or that I was wrong for feeling that way.  No-one actually enjoys being judged when the result is so important. 

For me, it simply meant that it was something I could deal with, gain perspective on and overcome in order to achieve a more important goal, which is moving forward.

Not for one second did I feel she was Gatekeeping.  I'd prefer my health professionals to be as comprehensive as humanly possible and as thorough as the situation warrants at all times.

YMMV.

I know there are crappy therapists and crappy Docs out there, and my heart goes out to anyone who has ever had the misfortune to be on the receiving end of obstruction, prejudice and ridicule from those who are supposed to be helping and do no harm, but every single experience is just that.  Singular, unique to that person.

That single experience can be shared as a cautionary tale, which is important to those seeking greater understanding and appreciated in that context.

I just feel strongly that presenting those personal, unique experiences as transgospel and pseudo-fact to label all things related in a negative light is dishonest and poorly done.

-Miki

Some instances need gatekeeping, some don't. I personally don't think HRT should require gatekeeping. HRT is not something that is irreversible (other than sterility and gynecomastia, and those come after an extended period of use. I think most people would be able to determine whether they're happier pre HRT than post HRT.

But then again maybe I'm just basing my opinion on how I can operate. My therapist did say I was one of the most grounded people (I assume he meant mentally speaking) he's ever had.

However things like SRS, orchiectomy, and extensive FFS should require some sort of guidelines. By FFS I don't mean things like a brow lift or a nose job, I mean things like jaw / chin reconstruction. These are extensive things that are expensive and alter you dramatically forever.

Whether or not the guidelines are too strict, or too standardized is another issue imo. Everybody is different, you shouldn't need to wait x amount of months or x amount of visits to get the approval, you should just be able to be assessed individually.

Quote from: Sephirah on April 11, 2012, 09:15:14 PM
Actually, yes.

http://www.minyanville.com/businessmarkets/articles/obesity-tort-law-tort-class-action/10/29/2010/id/30852?page=full

And there were the lawsuits against the tobacco companies because smoking gave people cancer.

Well, that case against mcdonalds was in brazil... so... i can't really speak to their laws. If people were winning cases against fast food for making them here in the USA... you can bet there would be a HUGEEEE (pun intended) line of people trying to make some quick money for being lazy.

As for tobacco companies... well...the issue there was they KNOWINGLY sold a product they knew was causing cancers (according to their own studies)... they hid the results... it isn't a case of people knowingly acting and then blaming their choices on someone else (smokers today can not sue the tabacco companies if they get cancer).

QuoteHowever things like SRS, orchiectomy, and extensive FFS should require some sort of guidelines. By FFS I don't mean things like a brow lift or a nose job, I mean things like jaw / chin reconstruction. These are extensive things that are expensive and alter you dramatically forever.

So... "normal" people can get all these surgeries without a therapist (because they have major self esteme issues, or looking for attention, or any other reason...good or not)... but, if we trans people want the surgery, it is because something might be wrong with our brains?

QuoteThis is exactly the point. When dealing with an issue stemming from the brain of an individual, you have to be sure that they are your own choices, and not influenced by a state of mind caused by something else, such as depression.

This is life... making choices are things people have to deal with every day. Making HUGE life or death choices... making choices that affect the rest of how you live.... people deal with these every day. And the thing is, people make choices for VERY bad reasons ALLLLLL the time. Because they have mental issues or baggage that they think they can fix by doing whatever they are doing....

But... why aren't we stopping them? Why don't we hold their hands? The exact arguments for why WE need it can be used for them. It could save so many "normal" people a lot of pain and suffering and making horrible horrible mistakes if they had a therapist there to approve what they were doing....

But... why aren't we?

Why are trans people so special that we need to be approved before we can do what we choose? Are trans people really that messed up that we need to be handled like children? That we can't make our own life-changing choices like the rest of the world?

Thrill seekers...

Thrill seekers die every year. Thousands and thousands of them.

Many go engage in these activities because they are unhappy in their jobs / marriages / life in general... they want to feel "alive".. and doing dangerous things is what they figure will make them happy.

Why are they allowed to do this? We aren't we stopping people from doing activities for kicks? We need to stop everyone going cliff climbing and try to fix them with therapy (to get to the base of their need for thrills)... or , if they feel they really need to experience it... then we should monitor them on indoor cliff-faces with safety equipment and specialists.

*face palm*

Quote from: Rabbit on April 11, 2012, 10:46:34 PM
So... "normal" people can get all these surgeries without a therapist (because they have major self esteme issues, or looking for attention, or any other reason...good or not)... but, if we trans people want the surgery, it is because something might be wrong with our brains?

I see where you're coming from, and I think you have a good point. But I don't think most "normal" people opt to have major reconstructive surgery in an attempt to look like the other gender. Yes, many people get a nose job or a face lift or whatever, but like I said, that's not what I was really talking about.

He face palmed, people.
That means someone said something stupid.

Quote from: JoeyD on April 11, 2012, 11:00:18 PM
He face palmed, people.
That means someone said something stupid.

haha!!! It does. I wanna know who!!

It was me wasn't it. It's usually me :(

Quote from: Alainaluvsu on April 11, 2012, 10:56:55 PM
I see where you're coming from, and I think you have a good point. But I don't think most "normal" people opt to have major reconstructive surgery in an attempt to look like the other gender. Yes, many people get a nose job or a face lift or whatever, but like I said, that's not what I was really talking about.

Oh, yea...they don't have it to look like another gender. They get chin implants, cheek implants, nose jobs... and all the other fun stuff because they want to look more pretty. They inject botox into their muscles so they look younger. They get face-lifts because they can't stand how they look.

But, all of that is ok because they aren't trans? They can do it because they have serious daddy issues and low self esteme.. and that is totally ok.

But, if they get it to look like another gender? Woaaa, that is when it becomes crazy?

Again, I don't know why we are so special. People do stuff all the time for HORRIBLE reasons. Deep mental issues that can be sorted out with therapy... but we let them do what they choose.

But, trans people... we are assumed to have mental problems? So, it is ok for us?

It's not because we have some sort of mental problem imo. I think it's just a case of whether somebody can really make it in this world as their target gender in a psychological capacity. I could point to a few people on this board as exhibits but... I'm not that catty :P

Quote from: Alainaluvsu on April 11, 2012, 11:01:11 PM
haha!!! It does. I wanna know who!!

It was me wasn't it. It's usually me :(

Awh no, not you!!!!! You're fine (:
YOU BETTER TURN THAT FROWN UPSIDE DOWN!!

It's just the whole comparing transition to dare devils or other irrelevant things.
When I read all this I go v________v

Quote from: Alainaluvsu on April 11, 2012, 11:03:33 PM
It's not because we have some sort of mental problem imo. I think it's just a case of whether somebody can really make it in this world as their target gender in a psychological capacity. I could point to a few people on this board as exhibits but... I'm not that catty :P

Well... being trans is still seen as a mental defect...soo....

I don't understand what you mean by "make it in this world as their target gender in psychological capacity" though?

One of my female teachers is the most crude person you have ever met... she dresses like a guy, talks like a sailor.... soo....I really can't wrap my head around what type of psychological capacity is needed to be a woman :|

Quote from: Rabbit on April 11, 2012, 11:08:15 PM
One of my female teachers is the most crude person you have ever met... she dresses like a guy, talks like a sailor.... soo....I really can't wrap my head around what type of psychological capacity is needed to be a woman :|

Basically, in a zero sum whatever, are less happy as a female than as a male.

Quote from: Jayr on April 11, 2012, 11:07:07 PM
Awh no, not you!!!!! You're fine (:
YOU BETTER TURN THAT FROWN UPSIDE DOWN!!

Aww ♥ ... ok :)

Hehe sorry sorry, I just get riled up when our own community wants to keep transgendered people in the world of "something is mentally wrong with this person because they are trans! who knows what else is wrong in their heads, probably lots" ...

I just strongly reject the idea that I'm mentally unfit because I am transgendered.... sorry.

Quote from: Rabbit on April 11, 2012, 11:12:28 PM
Hehe sorry sorry, I just get riled up when our own community wants to keep transgendered people in the world of "something is mentally wrong with this person because they are trans! who knows what else is wrong in their heads, probably lots" ...

I just strongly reject the idea that I'm mentally unfit because I am transgendered.... sorry.

I can totally understand that. I know exactly what I want. More now than ever, thanks to HRT and RLE (which, btw I did mention shouldn't need a psychs approval).

i do not find gatekeepers as a bad idea and I do not believe that transgender is a mental disorder. I know this because I had to take a psychiatric exam in order to be ordain. If I did not pass that exam, I pretty much could not be a pastor.

So, for me, it has nothing to do with mental disorders even though I will disagree heavily over a comment that all transwomen are mentally fine and dandy. But that's for another thread all together. 

It has to do with having someone to talk to in order to make sure you are making a right decision.

If you want to go into your transition without support then that's you're prerogative. 

If someone wants to go into transition with support and seek guidance along the way, there is nothing wrong with that either.

Quote from: Alainaluvsu on April 11, 2012, 10:56:55 PM
I see where you're coming from, and I think you have a good point. But I don't think most "normal" people opt to have major reconstructive surgery in an attempt to look like the other gender. Yes, many people get a nose job or a face lift or whatever, but like I said, that's not what I was really talking about.

Other people have just as drastic surgery to look VERY different than they do. How is that ANY different?

http://starcasm.net/archives/23945

She doesn't even look like the same person yet no one asked her to go through a bunch of psychotherapy. I could find much more extreme example of people with small, ugly chins having as massive of surgery as any MTF. I girl I know had her jaw broken and wired back to get rid of a slight overbite she had.

The difference here is cisgender people can't fathom wanting to change genders so they make up special rules for trans people because clearly we are all crazy. For that matter we are in the DSM and people on this forum are constantly cheering that we are! O.o

Quote from: Alainaluvsu on April 11, 2012, 11:03:33 PM
It's not because we have some sort of mental problem imo.

That is exactly what this is.

You do realize to get even a hormone letter you MUST be diagnosed as having "gender identity disorder" which is a mental disorder in the DSM don't you? Unless you are diagnosed as having this metal problem, you won't get HRT. Much less GRS. And people here are trying to promote extending this to FFS? THAT is a big >face palm<

Quote from: Annah on April 12, 2012, 07:59:19 PM
i do not find gatekeepers as a bad idea and I do not believe that transgender is a mental disorder.

It has to do with having someone to talk to in order to make sure you are making a right decision.

OK lets stick to the facts here OK? To get a hormone letter you have to be diagnose as having GID. You do realize GID is "Gender identity DISORDER" correct? You HAVE been diagnosed as having a mental disorder if you got a hormone letter or apporval for GRS. From what you just posted I'm not sure you realize this.

I recall recently Annah you argued AGAINST removing transgender from the DSM. I'm sorry girl, you can't have it both ways. You can't be for trans being in the DSM as a mental disorder and then also say you don't feel it is a mental disorder.

All this crap with gatekeepers is centered around it being a mental disorder!

That the "gatekeeping" process seems to be working for me is not the same as saying it works in general.

My understanding of my gender identity evolved over a long time, with the bulk of that understanding solidifying in the last 3 years. During that time I turned to 3 therapists (2 individual, 1 marriage), 5 clergy persons (3 Congregational/UCC, 1 Unitarian Universalist, and 1 Soto Zen), and 2 clergy interns (Congregational/UCC) for support.

Work with the first individual therapist stopped when it seemed the issue I had brought forth, depression, had been solved. Part of that solution was when I determined that I was androgyne/genderqueer/genderfluid. I began working with the second therapist at the suggestion of the marriage therapist, as she felt my then-wife and I would benefit from having personal therapists while in marriage therapy. It turns out, the marriage therapist was right.

I had another bout of extreme depression (usually considered a mental health issue) that stemmed from the fact that I was in the wrong body. Discussing this with my second therapist led to me starting transition, a decision that I made and she supported me in that decision.

This therapist, the marriage therapist, and the Zen priest got me through what was possible the deepest depression of my life, after my then-wife said she wanted a divorce. I was on Craigslist and eBay shopping for a gun to kill myself. This, too, is typically seen as a mental health problem. The UU and UCC clergy and interns also helped me a great deal throughout 2011.

In my case, I think it could be argued that I had mental health issues. These issues were, to me, side-effects of GID.

But, that's just my case. It seems to me that there are as many ways to transition as there are people who transition. What works for some won't work for others. If I want hormones prescribed by a US endocrinologist, it seems I have to go through these steps. Likewise if I want SRS with a US surgeon. However, I have discovered that there are ways to get hormones online, and there are non-US surgeons who don't require the letters, surgeons who seem to be well-respected, too.

For the time being, I am choosing to follow the guidelines as described in WPATH's Standards of Care. That is my decision.

In reading the responses to the thread, it seems that things have drifted away from the efficacy, or lack thereof, of such a system purely on its own merits, and whether it actually provides any form of benefit for the individual, into a sort of instinctive resentment that it's only applied to one specific group of people and not to everyone.

While this is understandable in this context, and one could pose the question of whether these processes would still be seen as grossly unfair and invasive if everyone were suddenly treated the same and the cause of that resentment was removed, that's purely hypothetical and is something entirely different to what I feel is the point of the thread. Namely that such a system has benefitted some people quite aside from why and how it's implemented, that there's a clear difference in experiences of people using it, and that one term isn't something which should be applied in a blanket statement based on bad experiences not shared by everyone.

Before this denigrates into ad hominem attacks and becomes personal, I'd just like to point out that just because someone doesn't share your view, that doesn't make it any less valid. Everyone is entitled to an opinion. And if one doesn't agree with someone else's view, at least respect it.

Quote from: Stephe on April 12, 2012, 09:17:03 PM
That is exactly what this is.

You do realize to get even a hormone letter you MUST be diagnosed as having "gender identity disorder" which is a mental disorder in the DSM don't you? Unless you are diagnosed as having this metal problem, you won't get HRT. Much less GRS. And people here are trying to promote extending this to FFS? THAT is a big >face palm<

Actually, that's a fallacy.. I have no diagnosis of GID.. The referral my psychiatrist wrote to the gynaecologist who manages my hormones simply stated that I 'was a good candidate for hormonal reassignment.'

I'm a strong supporter of the WPATH SoC's being followed.. The current version does suggest that a therapist do an assessment prior to HRT, but there is no longer any requirement for any period of therapy.. I think this is a good idea - as others of mentioned there are other issues that can manifest in similar ways - and not ones that transition will actually help..

WPATH are also very supportive of the idea that transsexualism is not a mental illness. I don't think it is either. I started seeing my therapist knowing that transition was what I needed. All he's really done along the way was make sure that I was fully aware of the decision I was making - and that I was ready to cope with what comes with, both good and bad.

As for RLE being required before SRS, I support this.. I wonder how many have realised that transition or SRS is not going to make them any happier during this period? I wonder how many of them have detransitioned?

As far as my psychiatrist or gynaecologist go, I'd not call them gatekeepers.. The gates have always been open to me, I just needed to be ready to walk through them.. I haven't technically met the requirements for having done 12 months RLE, but my surgery letter is available to me whenever I want it..

As to those of you who've had bad experiences with medical 'professionals'? Go find another one and have a chat to the appropriate Professional Association along the way..

I got to skip steps 'cause I'm pretty... I mean: "I can easily integrate as my target gender." Yay, gatekeeping?

The criteria used is so totally random. I mean, it's great some people got something out of it... but why couldn't you just go see a therapist for help with gender issues? Why do they need to hold the power for that to be a useful relationship? Personally, I feel less inclined to lie to people who aren't standing in judgement over me, who don't control my future.

Quote from: Annah on April 12, 2012, 07:59:19 PM
i do not find gatekeepers as a bad idea and I do not believe that transgender is a mental disorder. I know this because I had to take a psychiatric exam in order to be ordain. If I did not pass that exam, I pretty much could not be a pastor.

I had to take a psych exam in order to transition... I wonder what would have happened if I'd failed it. Maybe I'd have gotten help... or maybe I'd be dead. People are funny, delicate things. How many get a bad therapist and go home and slit their wrists?

Quote from: Sarah7 on April 12, 2012, 10:23:04 PM
I got to skip steps 'cause I'm pretty... I mean: "I can easily integrate as my target gender." Yay, gatekeeping?

The criteria used is so totally random. I mean, it's great some people got something out of it... but why couldn't you just go see a therapist for help with gender issues? Why do they need to hold the power for that to be a useful relationship? Personally, I feel less inclined to lie to people who aren't standing in judgement over me, who don't control my future.

I had to take a psych exam in order to transition... I wonder what would have happened if I'd failed it. Maybe I'd have gotten help... or maybe I'd be dead. People are funny, delicate things. How many get a bad therapist and go home and slit their wrists?

Doesn't that speak more to the specific quality of the care, not the relevance of the process, though?   

It is really interesting to me how varied people's experiences are.  It also highlights how inconsistent the application of SoC can be from provider to provider.

The one thing I went into all of this with was a very consumer-centric mentality.  I shopped for a solid therapist with experience and interviewed several before making a decision.  It was a bit funny to watch the reactions of a few I did not choose.  There was a real, "Why are you asking me all these questions?" reaction.  I was pretty honest with them that I was absolutely judging their ability to be helpful and engage in productive therapy with me, much in the same fashion I would if I were getting my vehicle repaired, or hiring any professional to provide any service.  This did not sit well with more than a few of them, and I immediately discounted them as potential therapists.  When my current therapist responded by detailing her experience, producing authorized testimonials and encouraging me to grill her on specifics such as process and goals, I knew she "got it" and was going to be a partner and advocate with and for me, not just someone I was paying to go through the motions.

I guess my point is, if you run into a crappy service provider, find another one.  You are the consumer here, you are the one with the decision-making power and authority around how you engage in the process.  I'm 2 months in, and have my letter for HRT, with zero speed bumps.  I believe pretty strongly that the lack of those bumps has in large part been due to me taking the time to find the right resource for me.

No-one condemns the entire auto-repair industry because they got a ->-bleeped-<-ty brake job at a single garage.  They just find a better garage.

-Miki

Quote from: Stephe on April 12, 2012, 09:11:41 PM

Other people have just as drastic surgery to look VERY different than they do. How is that ANY different?

http://starcasm.net/archives/23945

She doesn't even look like the same person yet no one asked her to go through a bunch of psychotherapy. I could find much more extreme example of people with small, ugly chins having as massive of surgery as any MTF. I girl I know had her jaw broken and wired back to get rid of a slight overbite she had.

The difference here is cisgender people can't fathom wanting to change genders so they make up special rules for trans people because clearly we are all crazy. For that matter we are in the DSM and people on this forum are constantly cheering that we are! O.o

She wasn't partaking in facial surgery in order to appear to be the opposite gender. It has nothing to do with being a nutjob. It has everything to do with helping the individual make sure that they are making the right decision for them.

I mean seriously... if someone is crazy, why encourage their lunacy by letting them do what they want and acting like it's treatment. Just because it's listed under the DSM as a mental disorder doesn't mean somebody is a lunatic

Quote from: Sephirah on April 12, 2012, 09:56:16 PM
While this is understandable in this context, and one could pose the question of whether these processes would still be seen as grossly unfair and invasive if everyone were suddenly treated the same and the cause of that resentment was removed, that's purely hypothetical and is something entirely different to what

Normal people would cry bloody murder.

Quote from: Miki on April 12, 2012, 10:51:10 PM

Doesn't that speak more to the specific quality of the care, not the relevance of the process, though?

No, I was critiquing the unbalanced power dynamic inherent in the process, and the damage that can do. I was saying that the process itself negatively impacts the quality of care by pushing patients to lie to their therapists, therapists to come up with their own biased rules for gatekeeping (seriously, could the "readiness" criteria be any more subjective?), and by forcing vulnerable patients into the hands of therapists with questionable ethics.

I would favour a fixed and non-subjective system: 1 year of HRT for SRS, and informed consent for HRT. Under this system you could access mental health professionals for assistance at your discretion, without an unbalanced power dynamic distorting the relationship.

There you made me say it the boring way. I preferred my first version.  :-\

Quote from: Sarah7 on April 12, 2012, 10:23:04 PM
I had to take a psych exam in order to transition... I wonder what would have happened if I'd failed it. Maybe I'd have gotten help... or maybe I'd be dead. People are funny, delicate things. How many get a bad therapist and go home and slit their wrists?

As of Sept 2011, the Standards of Care released by WPATH basically say that psychologists should simply guide people through, instead of blocking the gate. They have in fact gone so far as to say that it is unethical to try to "fix" somebodies gender identity.

Quote from: Sarah7 on April 12, 2012, 11:23:41 PM
There you made me say it the boring way. I preferred my first version.  :-\

Heh, sorry!  But..thank you for clarifying that.

I think if that unbalance of the dynamic was universal, experienced equally by everyone, fair enough.

It's really not, though.  Good and bad experiences seem 100% dependent on good or bad therapists, not the fact that seeing one is a facet of the existing process.

I absolutely agree with your take on a fixed and non-subjective evolution of the system, and hope it gets there some day. 

I want my medical interactions specialized to address the unique needs of transitioning.  Making the process and system more generic could lead to the care becoming more generic as well.  When a medical specialty becomes routine, standard and par for the course, advances in it tend to slow drastically.  That by removing that potential for an unbalanced dynamic might breed more generic treatment and more blind rubber stamping would be my only real concern.


-Miki

Quote from: Miki on April 12, 2012, 10:51:10 PM

No-one condemns the entire auto-repair industry because they got a ->-bleeped-<-ty brake job at a single garage.  They just find a better garage.

But the auto repair industry doesn't require you to go to the tire store first to have them tell the other shop it's OK to fix the brakes.

The whole point is, people who need therapy should go get it. No one is saying they shouldn't. I'm happy for the people who needed therapy and got it. I didn't need any.

I was am happy, not depressed and at peace with being trans. I was for all intents and purposes already fully transitioned, I had been living full time as a woman for several years. I just wanted to start -legal- HRT and to do so was FORCED to get therapy I didn't need. I have a feeling if I had needed therapy, the therapist I saw would have been very good and helpful. The reason I say she was clueless is because I never needed her services to start with. I also know if/when I decide to have GRS, I will be subjected to more of this.

Using my/your above example: what if you were forced to go to the tire store first before you were allowed to get your brakes fixed at the other place and they made you wait for several months before they would OK your brake job. Made you come in for several inspections at your cost. So you had to drive around for months with grinding brakes. You know you need brakes but you can't get them. Would you then say "I'm so glad I was forced to go to the tire store first because some people need their tires replaced, yet don't know it, and I want what's safe for them."? Of course not.

The ONLY reason they do this is: being transgendered is in the DSM and it IS considered a mental disorder.

Quote from: Alainaluvsu on April 12, 2012, 11:21:42 PM
She wasn't partaking in facial surgery in order to appear to be the opposite gender.

Thank you for making my point. She can radically change her appearance for any reason as long as it's not to look like the other gender.. At that point you need a mental health professional's approval. And you feel this isn't because they think we are nuts for wanting to appear to be the other gender?

Quote from: Stephe on April 13, 2012, 12:02:16 AM
Thank you for making my point. She can radically change her appearance for any reason as long as it's not to look like the other gender.. At that point you need a mental health professional's approval. And you feel this isn't because they think we are nuts for wanting to appear to be the other gender?

No

Because living as the other gender can be a bit more than somebody may have been prepared for. Simply being uglier or prettier is nowhere near as difficult a challenge for most people.

The "approval" imo should be more of a gut check of the patient than a "Ok I think you're crazy enough! You pass my nutso test! Go get your balls removed, your chin carved, and your penis turned inside out because you're a nutcase and there is no reasoning with you!" ... which btw, I highly doubt that's how anybody takes the process.

Quote from: Stephe on April 12, 2012, 11:56:13 PM
But the auto repair industry doesn't require you to go to the tire store first to have them tell the other shop it's OK to fix the brakes.

The whole point is, people who need therapy should go get it. No one is saying they shouldn't. I'm happy for the people who needed therapy and got it. I didn't need any.

I was am happy, not depressed and at peace with being trans. I was for all intents and purposes already fully transitioned, I had been living full time as a woman for several years. I just wanted to start -legal- HRT and to do so was FORCED to get therapy I didn't need. I have a feeling if I had needed therapy, the therapist I saw would have been very good and helpful. The reason I say she was clueless is because I never needed her services to start with. I also know if/when I decide to have GRS, I will be subjected to more of this.

Using my/your above example: what if you were forced to go to the tire store first before you were allowed to get your brakes fixed at the other place and they made you wait for several months before they would OK your brake job. Made you come in for several inspections at your cost. So you had to drive around for months with grinding brakes. You know you need brakes but you can't get them. Would you then say "I'm so glad I was forced to go to the tire store first because some people need their tires replaced, yet don't know it, and I want what's safe for them."? Of course not.

The ONLY reason they do this is: being transgendered is in the DSM and it IS considered a mental disorder.

I get it, and cannot disagree that in your case, that sense of frustration is completely warranted.  I'd be pissed off, too.  I'm kind of in the same boat, not unsure, not freaked out or ragged over it, not at my wits end or even slightly confused about my path forward.  I could resent seeing my therapist, but am actually finding it amazingly helpful for putting my choices in context of how it impacts and affects my relationships and those around me. 

Where my analogy, and any analogy honestly, breaks down is that what we're doing in not shopping for shoes or tires or getting a car fixed.

It is not a commonplace activity at all, and empirical data demonstrates that a wide range of co-morbid mental health issues can and do manifest side by side and addressing those is far more beneficial than ignoring them. 

The fact that our personal experiences don't fall into that category doesn't mean the category doesn't exist or is invalid across the board in context of any process.

What would transitioning look like if GID were removed from the DSM?  (Which I hope it will be eventually, but with some structured SoC still existing.)

How would reasonable checks and balances exist absent a medical validation via a diagnosis?

-Miki

Quote from: Alainaluvsu on April 13, 2012, 12:07:08 AM
No

Because living as the other gender can be a bit more than somebody may have been prepared for. Simply being uglier or prettier is nowhere near as difficult a challenge for most people.

Bzzz try again, I was required to jump through all these hoops even though I was already living full time and had been for years.

That's the problem with this cookie cutter approach you guys are in favor of. Some people praise it because they fit into the needs/steps it sets up. There are many people who have no need for every step or got through those steps without "professional help".

Some people need professional help to walk out the front door of their house. Should everyone be required to get professional help before they walk out of their house because some people might? This is no different.

Quote from: Stephe on April 13, 2012, 12:15:56 AM
Bzzz try again, I was required to jump through all these hoops even though I was already living full time and had been for years.

That's the problem with this cookie cutter approach you guys are in favor of. Some people praise it because they fit into the needs/steps it sets up. There are many people who have no need for every step or got through those steps without "professional help".

Some people need professional help to walk out the front door of their house. Should everyone be required to get professional help before they walk out of their house because some people might? This is no different.

First of all, I was supporting an idealistic approach, and not telling the world whatever happened to you was necessary. So, you BZZ try again.

Second of all, I'm not in favor of any cookie cutter approach, if you scroll back I said it should be individualized.

Third of all, your analogy of needing help walking out of their front door is ... completely out of range of what we're talking about. There's some people who need medical assistance with walking, and there's others who seek to change their gender. Gender is a social construct that society holds heavily

... oh dear God do I really need to explain this for another paragraph??

Oh, and fourth of all, have you read the new WPATH standards? You should, it's gone to a very individualized approach. They go so far as to say in order to get HRT, a psych eval is recommended, but not necessary. They also say you can get an orchiectomy with a well documented history of GID and 12 months of HRT. The HRT is necessary to sample hormones to the patient before they can make irreversible changes. No RLE is needed.

Quote from: Miki on April 13, 2012, 12:12:07 AM
What would transitioning look like if GID were removed from the DSM?  (Which I hope it will be eventually, but with some structured SoC still existing.)

How would reasonable checks and balances exist absent a medical validation via a diagnosis?

I feel HRT should be informed consent and any doctor who feels a patient isn't a good candidate, for whatever reason, can request/suggest therapy first. That could be part of the informed consent. I feel it being in the DSM is just proclaiming"You people are fruit loops"

GRS should require a time period on HRT, if nothing else, to make sure the patient can tolerate being on estrogen. I also see having RLE for a certain time being a requirement to make sure the person likes living as the gender they think they want to live as. Sometimes reality is different that what we think it will be. If someone has been on HRT for a year and RLE for even 6 months, I feel they should know if this is the path they want to take. Again if a doctor wants to make more stringent demands, that's up to them.

Quote from: Alainaluvsu on April 13, 2012, 12:25:13 AM
First of all, I was supporting an idealistic approach, and not telling the world whatever happened to you was necessary.
......

Third of all, your analogy of needing help walking out of their front door is ... completely out of range of what we're talking about. There's some people who need medical assistance with walking, and there's others who seek to change their gender. Gender is a social construct that society holds heavily

First, the problem with an "idealized approach" is that it only works for specific cases. You assumed who ever was having surgery or wanting HRT had no concept of what living full time is like. You said as much in your post, which is why it was a fail..

Third, I was talking about agoraphobia. People who needs psychiatric therapy to walk out of their house. You assume here that everyone need psychiatric therapy to transition. There is absolutely no difference between the two in my analogy. Just because some people need psychiatric help to walk out their front door, doesn't mean everyone does.

As far as the "Gender is a social construct that society holds heavily ", I haven't found that to be as big a deal as a lot of people make it out to be. Most of the people who make this a huge deal are people here who haven't transitioned yet and assume it's a huge problem.

Quote from: Stephe on April 13, 2012, 12:31:28 AM
I feel HRT should be informed consent and any doctor who feels a patient isn't a good candidate, for whatever reason, can request/suggest therapy first. That could be part of the informed consent. I feel it being in the DSM is just proclaiming"You people are fruit loops"

GRS should require a time period on HRT, if nothing else, to make sure the patient can tolerate being on estrogen. I also see having RLE for a certain time being a requirement to make sure the person likes living as the gender they think they want to live as. Sometimes reality is different that what we think it will be. If someone has been on HRT for a year and RLE for even 6 months, I feel they should know if this is the path they want to take. Again if a doctor wants to make more stringent demands, that's up to them.

Stephe, you can't see it, but I am doing that whole thoughtful nodding thing reading this. ;p

So, you'd be in favor of a medical diagnosis governed by informed consent replacing a mental health diagnosis?

That looks good on paper, and it would not surprise me if that ends up being a huge aspect of how GID identification and treatment evolves.

You don't have any concerns at all that shifting to a purely medical condition would codify insurance/provider standards of care in unfavorable or more discriminatory ways? 

The medical industry is still profit based, and non-standard services and treatments tend to either become genericized as afterthoughts, thereby degrading the level of care,  or made inaccessible by higher pricing structures that categorize them as elective choices, not required treatments.

Would a purely medical diagnosis still make that critical distinction between need and want?  Choice and necessity?

-Miki

I hear what you're saying, Sarah.

Wanted to take a breather and thank everyone who is sharing in this thread.  I genuinely appreciate the variety of opinions and the very personal experiences that have crafted them. 

These types of discussions can't be parsed into simply right or wrong, and I'm thankful that some honest debate and questioning of why people hold certain viewpoints can occur both within the gray and without any raging infernos.

Thank you.

-Miki

I think a lot of you have this backwards.

It is not that therapists are trying to stop me from transitioning, their primary purpose was to determine that I had no underlying mental illness that manifested transitioning as a symptom.

What if I had multiple personality disorder or some order form of illness that really needed treatment? What if they treated it and my desire to transition disappeared?

What they said to me was that I was free from mental illness and my condition was physical one that was set before I was born.

They still talk to me to ensure that my continuing journey does not introduce any mental illness. In short they are looking after my mental health as much as the doctors look after my physical health.

Quote from: Beverley on April 13, 2012, 03:15:02 AM
It is not that therapists are trying to stop me from transitioning, their primary purpose was to determine that I had no underlying mental illness that manifested transitioning as a symptom.

So, you don't see anything wrong with them telling you that because you are transgendered... you are unfit to make life-altering choices on your own (like normal people are able to)? That you are not allowed to decide what to do with your own body without someone else writing you a permission slip first?

For normal people, therapy is an OPTION for those going through difficult times and making life-altering choices.... not something forced on them before they are allowed to live their lives.

I guess I spent too many years as a "normal person" before I came out as transgendered. Just think, 14 months ago I was actually free to decide what I wanted to do with my body ~shrug~ Maybe I need to get used to this new status as a mentally questionable person.



To sum it up...

A normal person is, by default, assumed to be sane enough to make his or her own choices.

A transgendered person is, by default, assumed to be mental disturbed and unable to make his or her own choices.



That is where my problem is. I don't like to be thought of as crazy by default... I don't want to walk down the street and people look at me and question my sanity ... or needing to PROVE that I'm sane.

Quote from: Beverley on April 13, 2012, 03:15:02 AM
I think a lot of you have this backwards.

It is not that therapists are trying to stop me from transitioning, their primary purpose was to determine that I had no underlying mental illness that manifested transitioning as a symptom.

What if I had multiple personality disorder or some order form of illness that really needed treatment? What if they treated it and my desire to transition disappeared?

What they said to me was that I was free from mental illness and my condition was physical one that was set before I was born.

They still talk to me to ensure that my continuing journey does not introduce any mental illness. In short they are looking after my mental health as much as the doctors look after my physical health.

In my opinion, this cuts to the heart of the issue. Transition, whether surgical or non-op, is a very significant change to one's state of being. Given that GID and/or Gender Dysmorphia may sometimes be symptomatic of a deeper underlying condition, I think an overall evaluation to rule out other conditions as well as some ongoing transition guidance are very good ideas. However, I do oppose Gatekeeping practices that show a tendency to be generally biased against transition from the outset. Ultimately, it is your body and as long as you are thinking clearly and rationally you should ultimately have control over whether you pursue HRT, FFS, GRS, just crossdress once in a while, or even decide to continue living as your birth-assigned gender.

When I speak of "Gatekeepers", it is almost always in the sense of someone who decided to say "no" before you even entered the office, whereas I regard "Cheerleaders" as being the reckless opposite face of that coin. What is needed is someone who sits between these extremes and can help you choose your path ahead wisely, even if it eventually leads full circle into not transitioning at all; someone who is a counselor, information resource, shoulder to cry on, and facilitator.

In the publishing world, they are seeing the rise of "Book Shepherds". These are professionals who are not actual publishers or editors, but will guide you along the path of taking your book from rough draft to fully self-published high-quality paper book and/or ebook. They help you decide on the best approach for your project, help you identify what resources and services you will need (especially the ones you didn't even know existed), what the benefits and drawbacks are of various options, how to approach marketing, how to be taken seriously by booksellers, and so forth. You have to do all the work, but they provide knowledge and experience that a new author lacks and without which the book becomes just another amateurish overlooked poor-quality ebook among thousands already online.

In the context of all things trans, I think what we ideally need are more unbiased Transition Shepherds who can help ensure that you are, in fact, thinking clearly and are well-informed, and can help guide you to the necessary resources for your own personal path. If you have already been living as your self-identified gender for a good while and are happy that way, then the Transition Shepherd may just need to step back and be available to you in times of crisis, whereas if you are still deep in the questioning phase, the Shepherd may play a vital role in helping you figure out who and what you are as well as what path ahead will lead you to the best possible quality of life. This, I believe, is the general intent of Standards of Care even if they are not always implemented in accordance with that spirit or intent.

I think of my therapist as a Transition Shepherd because that is essentially the role she plays for me. The decision to transition is mine, but she plays an indispensable part in getting me safely to that destination and making sure I have realistic expectations of what life will be like when I get there.

If this seemed a bit rambling and incoherent, I can only plead sleep deprivation. Lots of long workdays and short nights lately. Vacation next week, though. Yippie!

Quote from: Rabbit on April 13, 2012, 03:35:08 AM
So, you don't see anything wrong with them telling you that because you are transgendered... you are unfit to make life-altering choices on your own (like normal people are able to)? That you are not allowed to decide what to do with your own body without someone else writing you a permission slip first?

No. Because that is NOT what they are telling me.

Quote from: Rabbit on April 13, 2012, 03:35:08 AM
For normal people, therapy is an OPTION for those going through difficult times and making life-altering choices.... not something forced on them before they are allowed to live their lives.

And as I said, they ensured that I was a normal person and therefore that my life-altering choices were not being forced on me by some form of mental problem.

I cannot see the difficulty with this.

The Gatekeeper situation is far worse in the U.K within the NHS GIC system. In the U.K regardless of your GD diagnosis they will stall you and stall your progress for as long as possible. It was 10 years ago now but In order for me to start of HRT I had to see a private psychiatrist in the end as I wasn't able to get on HRT through the NHS GIC system.

Because the U.K's NHS is tax payer run and not privately run they will give you all kinds of hassle to stall your transition.  Those were my experiences when I went through the NHS.

Quote from: Annah on April 11, 2012, 06:08:15 PM
Some people assume that if you do not mind the gateway process then you're a tool and you cannot effectively manage how a therapist treats you. In my opinion, that's just an unproductive stereotype that does utterly nothing but divide people. When people call those who enjoyed their therapy experience as cheerleaders, you can only shake your head and feel sorry for them for being so narrow minded.

Can't argue with that.

Most therapists are helpful. Most Drs only have our best interests and some issue are too complicated for the layman.

I object because I need to seek effective permission, (dress it up any way you wish, it is what it is), to do manage my own body.

There are, of course, many people with all sorts of positive experiences. That's super. But with respect, these are isolated cases, even if there were in the majority.

Most people are expected to go through real life experience. Fine. But I don't need real life experience. I live it.

Most people are faced with an all or nothing. Fine, but I don't want/need all or nothing.

I need control over my own body. If I choose to seek therapy or anything else, that will be my choice.

It is ONE very, VERY touchy subject, - at least for me.

On the one hand I have seen folks "rubber-stamped" and NOT for the better of them and their situation, and on the other end of the scale was my own VERY disturbing process.
To the point that if you don't pass the "gate" who cares if you committed suicide!
You just then 'had it coming to you' - were to 'weak' an individual to transition...
No more "what's best for the patient..." show me the money - the name of the game.
Crying during "therapy" was considered just such a display of weakness, not dressed according to -therapist's- personal taste, no good! Not being involved with a male sexually, not good, don't pass.
Just sick and abhorrent!

So, in the end it seems "everyone to his/her own..." there are good, and pretty well not so good therapists... some truly do not deserve their title.

If you have only ONE just such an individual as the ONLY "gatekeeper" for the whole country (SA) then it does get VERY, VERY painful and most upsetting in deed.

If one has a choice... well, then call yourself lucky.

Axélle

First the differences between NHS and everything else, everywhere else are not valid, no one else has a system quite like NHS (thank god).  And at that, nothing could be further from the NHS model (be it good or bad) than the US system.  So it's absurd to compare them.


Ridiculous yammering is ridiculous.
Oh, you must be new here.

But, trans people... we are assumed to have mental problems?
So long as it's in the DSM, so long will you really have 'mental problems' according to the Big Book of Mental Problems.  Drop it, and so long insurance funding.

What would transitioning look like if GID were removed from the DSM?
Incredibly expensive for individuals, beyond the range of many who now get it. 

Other people have just as drastic surgery to look VERY different than they do. How is that ANY different?
Normal people would cry bloody murder
First, RLT and HRT are things that can be backed out of, surgery, not so much. 

Second, because of this, and because HRT in many places is not subject to gate-keeping it because it's offered on an informed consent basis (at a public health facility) and since it's you making the diagnosis, and you taking the medicine it leaves very little room for blaming (suing) anyone else.  SRS/FFS on the other hand do involve others, high-payed and highly trained specialists.  Those people CAN be - and are - sued by others.  To protect themselves, their investment in themselves, their practice upon which both their family and their patients depend they require a huge measure of cover your ass.

To that degree not only SRS but increasingly many more plastic surgery procedures (and plastic surgeons) are requiring psych evalus for their patients.  (This was common up to the 1950s, it's just making a resurgence.)  Google it and you'll find almost 3 million hits for the topic of psych evalus for plastic surgery.

In 2009 alone, nearly 10,000,000 individuals sought cosmetic procedures in the U.S. alone (Sclafani, 2010). With this growing interest and number of people seeking cosmetic procedures, it has also become important to evaluate the patient's motives and understand what they think plastic surgery can do for them. Unrealistic expectations or impure motives can lead to problems for both the individual undergoing the procedure, as well as the doctors involved in performing the surgery. It is for this very purpose that many individuals are now being referred for psychological evaluations before cosmetic procedures are agreed upon. And in cases when patients may not need formal evaluations, cosmetic surgeons are being trained to be more aware of what to look for in applicants for cosmetic surgery.
http://voices.yahoo.com/why-psychological-evaluations-necessary-8276069.html


You think you are being singled out and picked on, when you're not.  It part of a general trend.

Quote from: tekla on April 13, 2012, 10:31:49 AM
First the differences between NHS and everything else, everywhere else are not valid, no one else has a system quite like NHS (thank god).  And at that, nothing could be further from the NHS model (be it good or bad) than the US system.  So it's absurd to compare them.

Many of us in the U.K have no choice but to go through the NHS system, so it is valid to those of us who live in the U.K.

The topic is about 'gatekeeping' which applies to all people and all countries not just the USA. 

I'm just saying that any comparison between the two systems is going to end up being disingenuous.  I'm not even sure the word 'gatekeeping' is used for the same reasons, in the US it's primarily to guard against lawsuits, in the UK it's meant to keep the general costs down.

Quote from: tekla on April 13, 2012, 11:19:24 AM
I'm just saying that any comparison between the two systems is going to end up being disingenuous.  I'm not even sure the word 'gatekeeping' is used for the same reasons, in the US it's primarily to guard against lawsuits, in the UK it's meant to keep the general costs down.

'Gate keeping' over here is meant as the analysis and diagnosis of gender dysphoria although there have been several cases over here within the NHS where the 'Gatekeeping' has not worked and those recommended for surgery show regret and return to their previous gender role after surgery.

Our private system is probably more like yours in the USA. There was a high profile case of a wealthy transsexual who transitioned privately and then decided after surgery that she wanted to sue the psychiatrist for recommending her for surgery as she wanted to revert back to being a man. 

I guess I chose my therapist well, she wasn't a fan of what people call gatekeeping and it was basically up to me to say whether I was this or that or whatever. She felt she was there to guide me and help me work out any bumpy spots. I probably dealt with her more with grief counseling at the time because my grandmother passed and my dad was terminally ill. I got the hrt letter within a couple sessions and the surgery letter was available within 8 months or so, even though I haven't had need of it yet due to being generally poor.

Quote from: tekla on April 13, 2012, 10:31:49 AM
You think you are being singled out and picked on, when you're not.  It part of a general trend.

I agree with a lot of your post. I can see there needs to be some sort of eval before FFS/GRS but I'm not in agreement that a psych eval is what is needed.

HRT: informed consent should be all that's needed. The meds just aren't that expensive either for most people to just buy them. If someone needs insurance to pay for them or insurance won't pay for the doctor visits or the blood tests, then those people can go for a psych eval for the GID disorder diagnosis.

Any major FFS: a time period of HRT (if nothing else to make sure of what is really needed). I don't think things like an obviously ugly nose etc should require anything. I also think part of a cosmetic surgery training should be in evaluating the patient. I know my FFS doc asked some questions about my goals and what I expected. About why I thought this would improve my life etc. He was aware I was living full time and I was referred to him from my GP for this work. He suggested a lot of things but put zero pressure on me to do more than I wanted. I wonder if all FFS are this low key or are they doing a hard upsell for the "full boat" knowing how fragile most TG patients self image is?

GRS, RLE to make sure the person is happy living in that gender role. If someone is living full time for 6 months to a year, I think that proves they want to live this way.

As far as the DSM and diagnosis with GID, if someone needs this for insurance, then add that requirement based ONLY on the insurance companies requirement. Let the insurance company pay for this too. I'm self pay, as I can't afford an insurance plan in the US that would cover this, so all of this insurance won't cover it stuff doesn't apply to me. *But* I am still required to be diagnosed with a mental disorder and pay for it out of my own pocket before I can proceed with even HRT..

I see this like if your car is in a wreck. If you have insurance you might be required to get 3 estimates of the repair cost before the insurance company will approve it. If you are paying for it yourself, you just go get the car fixed if you work out a deal with the shop. And many times at a lower rate than if they were having to deal with the insurance company.  If someone has to do extra stuff because they are dealing with insurance, people who are not insured shouldn't be subjected to the same hoop jump. Doesn't that make sense?

I have a feeling if the insurance companies figure out this psych eval they require is just costing them more money, that requirement would disappear.

Quote from: Jaime on April 13, 2012, 12:24:16 PM
I guess I chose my therapist well,

I'm sure my therapist would be great for someone who was just coming to terms with being trans. I was way past the point of needing therapist help figuring this stuff out. I don't think a different therapist would have made any difference in my case. It's not that my therapist was a bad therapist, it's that I didn't need one at all to start with. It would be like going to a knee surgeon when there is nothing wrong with my knee, just to make sure...

Quote from: Miki on April 13, 2012, 12:57:04 AM
You don't have any concerns at all that shifting to a purely medical condition would codify insurance/provider standards of care in unfavorable or more discriminatory ways? 

The medical industry is still profit based, and non-standard services and treatments tend to either become genericized as afterthoughts, thereby degrading the level of care,  or made inaccessible by higher pricing structures that categorize them as elective choices, not required treatments.

Would a purely medical diagnosis still make that critical distinction between need and want?  Choice and necessity?

I feel this is where the insurance companies and their requirements might add extra hoops that people who want this covered would have to jump through. It's not unheard of in other cases to get a special diagnosis or refferal before something is covered. If the insurance company requires a psych eval for further procedures, the patient then has to decide if they want to go through all of that or just pay for it themselves. Given how profit oriented insurance companies are, I wonder how long adding these extra cost services would remain a requirement?

As far as the DSM, I have no real problem leaving it in there if it's needed by some people. What I have a problem with is: being required to being diagnosed with a mental disorder before I can get physical treatment, when I am the one having to pay for it.

BTW "elective treatments" are usually FAR less expensive than required ones. Things like cosmetic surgery are given special low rates at a hospital over something like knee surgery. I've had both and a procedure that was aprox same time on the table was 3X more expensive (hospital fees) when it wasn't an elective procedure, even though both times I was self pay.

I have a feeling if the insurance companies figure out this psych eval they require is just costing them more money, that requirement would disappear.

I think most of this is being driven by malpractice insurance carriers.

When I came out to my father... he thought I was just confused / crazy. He dismissed my feelings and figured I was just mentally unstable... said I should go see a therapist.

It is kind of depressing people who support mandatory therapists agree with him... because that is exactly what you are saying.

Under this system... people having a first reaction of "wow, you are likely bat crazy" when you try to tell them you are trans is COMPELTELY justified. Coming out to parents and friends before starting down the road? Well, you better not... they will just say you likely need mental help.

I actually still don't have a therapists letter (even after 13 months on hormones)... so.. I guess everyone should worry about if I'm mentally stable still. You know, because having trans feelings means there is probably something wrong with you?

My brothers and sisters don't have therapist letters proving they are sane either... but, they are cis, so I guess they don't need one?

If I were a normal person learning about transgendered people, I wouldn't trust them (at least not until they had a therapist letter they could show me, maybe 2 or 3 just to be safe). I mean, the trans community itself believes it is pretty likely you are nuts if you are trans!!

When we come out as trans, our status goes from "normal person" to "probably crazy person"... then we need to see a therapist for months and get them to re-grant us "normal person-kind of" status?

I am kind of shocked so many people here believe that having transgendered feelings justifies being thought of as a nut .

If I wanted to work out, get huge muscles, reshape my body to be more manly, get surgery to make myself look more masculine (muscle implants, facial surgery, whatever)... that would be normal, I would just be a guy wanting to be a manly guy. But, if I feel like I would rather have more feminine attributes? That means something is probably wrong with my brain... I need to get checked out first....

Afterall...men should be men right? They should have sex with women and be big and strong. Anything different is a mental defect?


Cool....

It's just that 'transgender' alone is not a monolith - it's a spectrum with many points on it, and many people in here have found that we don't have to go all the way to the end to find satisfaction or happiness.  So perhaps, particulary for the younger people, it makes sense to know they have gone through all the options before settling on the most drastic ones first.

Anyone who has been around these boards for a while has seen evidence of:
- people with other problems that could interfere with transition, or mask it, or enhance it
- people who seem to be making decisions without the full range of options before them
- lots, and lots, and lots of people with unrealistic expectations

to a degree, therapy helps with many of those things.

Granted these standards (like most standards) are pitched to the lowest common denominator, but enough lawsuits could stop any and all of these procedures, so some caution might be prudent.

Quote from: Rabbit on April 13, 2012, 03:59:55 PM
When I came out to my father... he thought I was just confused / crazy. He dismissed my feelings and figured I was just mentally unstable... said I should go see a therapist.

It is kind of depressing people who support mandatory therapists agree with him... because that is exactly what you are saying.

Under this system... people having a first reaction of "wow, you are likely bat crazy" when you try to tell them you are trans is COMPELTELY justified. Coming out to parents and friends before starting down the road? Well, you better not... they will just say you likely need mental help.

I actually still don't have a therapists letter (even after 13 months on hormones)... so.. I guess everyone should worry about if I'm mentally stable still. You know, because having trans feelings means there is probably something wrong with you?

My brothers and sisters don't have therapist letters proving they are sane either... but, they are cis, so I guess they don't need one?

If I were a normal person learning about transgendered people, I wouldn't trust them (at least not until they had a therapist letter they could show me, maybe 2 or 3 just to be safe). I mean, the trans community itself believes it is pretty likely you are nuts if you are trans!!

When we come out as trans, our status goes from "normal person" to "probably crazy person"... then we need to see a therapist for months and get them to re-grant us "normal person-kind of" status?

I am kind of shocked so many people here believe that having transgendered feelings justifies being thought of as a nut .

If I wanted to work out, get huge muscles, reshape my body to be more manly, get surgery to make myself look more masculine (muscle implants, facial surgery, whatever)... that would be normal, I would just be a guy wanting to be a manly guy. But, if I feel like I would rather have more feminine attributes? That means something is probably wrong with my brain... I need to get checked out first....

Afterall...men should be men right? They should have sex with women and be big and strong. Anything different is a mental defect?


Cool....

There's a difference between "Let's rule out other things that could be a contributing factor, before undergoing major, irrevocable life-changing surgery, to make sure it's really what you want and something which will allow you to live your life to the fullest." And "omg you're madder than a box of frogs, wtf is wrong with you??"

I don't think that anyone here is advocating the use of a system which bases its whole ethos on the latter. I can see why you feel the way you do based on your own past experiences, but reading through the replies here, I don't see anything of that nature being supported at all.

Sanity or insanity isn't in question, merely the best approach to allow a person to be who they want to be.

Everyone's experience is clearly very different - but my experience of the "gatekeepers" so far has been of people who see their role as trying to get the gates open for me, not trying to close them.

Quote from: Padma on April 13, 2012, 04:24:01 PM
Everyone's experience is clearly very different - but my experience of the "gatekeepers" so far has been of people who see their role as trying to get the gates open for me, not trying to close them.

Me too, actually.

Quote from: Sephirah on April 13, 2012, 04:11:23 PM
"Let's rule out other things that could be a contributing factor, before undergoing major, irrevocable life-changing surgery, to make sure it's really what you want and something which will allow you to live your life to the fullest."

Why isn't it required of normal people undergoing "major, irrevocable life-changing surgery" and choices?


Answer:

Because a normal person is assumed to be a free rational adult capable of deciding what to do with their own bodies...... and we, are not.




I'm not saying therapy is evil or bad or that it can't help people figure stuff out. Normal people use it too....

I'm saying, FORCING me into therapy before you "let" me choose how to live my life is a problem.

Maybe this is a cultural thing though... I'm from america... where we value personal freedom.

Why isn't it required of normal people undergoing "major, irrevocable life-changing surgery" and choices?


Answer:

Because a normal person is assumed to be a free rational adult capable of deciding what to do with their own bodies...... and we, are not.

Increasingly it is.  Particularly for major plastic work.

Quote from: tekla on April 13, 2012, 04:56:50 PM
Increasingly it is.  Particularly for major plastic work.

Like?

I know its hard work to scroll up and all but...

In 2009 alone, nearly 10,000,000 individuals sought cosmetic procedures in the U.S. alone (Sclafani, 2010). With this growing interest and number of people seeking cosmetic procedures, it has also become important to evaluate the patient's motives and understand what they think plastic surgery can do for them. Unrealistic expectations or impure motives can lead to problems for both the individual undergoing the procedure, as well as the doctors involved in performing the surgery. It is for this very purpose that many individuals are now being referred for psychological evaluations before cosmetic procedures are agreed upon. And in cases when patients may not need formal evaluations, cosmetic surgeons are being trained to be more aware of what to look for in applicants for cosmetic surgery.
http://voices.yahoo.com/why-psychological-evaluations-necessary-8276069.html

The eight danger signs that surgeons should be vigilant for when dealing with patients are:
· A preoccupation with an imagined defect
· Excessive concern over a minor blemish or flaw
· A perceived flaw causing significant distress and impaired social or working life
· When their preoccupation is not accounted for by another mental disorder
· Multiple consultations for surgery
· Multiple surgical procedures
· Unrealistic expectations about the outcome of the surgery, such as wanting to look like a particular movie star
· Lack of clarity about their goals for the procedure
http://www.guardian.co.uk/society/2006/sep/22/health.medicineandhealth1

Find another TWO MILLION EIGHT HUNDRED THOUSAND articles here:
https://www.google.com/search?aq=f&sourceid=chrome&ie=UTF-8&q=psycheratic+evaluations+for+plastic+surgury#hl=en&sa=X&psj=1&ei=-KGIT47LE4qriQK02fieCA&ved=0CGsQvwUoAQ&q=psychiatric+evaluations+for+plastic+surgery&spell=1&bav=on.2,or.r_gc.r_pw.r_cp.r_qf.,cf.osb&fp=fa3850a2e10b61fd&biw=1280&bih=651

Quote from: Rabbit on April 13, 2012, 04:51:03 PM
Why isn't it required of normal people undergoing "major, irrevocable life-changing surgery" and choices?

Answer:

Because a normal person is assumed to be a free rational adult capable of deciding what to do with their own bodies...... and we, are not.

I am sorry, but you are simply wrong.

I have seen plenty of other examples of people being refused things that are not in their own best interests. A very simple example would be a tattoo artist refusing to do a certain tattoo. Other more relevant examples are normal, fertile women (or men) insisting on being sterilised because they do not wish children. Many doctors simply refuse to do such operations. I have seen examples in the news of people who wish to have healthy limbs amputated. There are lots of things that apparently healthy, sane people want done to them that practitioners refuse to do.

A recent example (at least here in the UK/EU) is the situation of people with a terminal disease who wish to kill themselves (assisted suicide). These people are mentally sound, have a clear understanding of their situation and have often studied their future options in depth. Yet doctors refuse to help them. Admittedly there is a legal issue that requires some stepping round but the point is that these people believe that the medical practitioners should be helping them to have a peaceful end to their lives rather than screaming their last days in agony.

Quote from: Rabbit on April 13, 2012, 03:59:55 PM
When I came out to my father... he thought I was just confused / crazy. He dismissed my feelings and figured I was just mentally unstable... said I should go see a therapist.

Whereas I did it the other way round I saw the therapist first and then told people that I had been diagnosed with a medical condition. This stopped anyone from calling me crazy and for many made it easier to accept what was happening to me because they understood that I was NOT crazy and that this was NOT a choice. It was something that I required treatment for and I was getting the correct treatment.

 :police:

Okay, folks, let's keep it civil please.

Quote from: tekla on April 13, 2012, 10:31:49 AM
First the differences between NHS and everything else, everywhere else are not valid, no one else has a system quite like NHS (thank god).  And at that, nothing could be further from the NHS model (be it good or bad) than the US system.  So it's absurd to compare them.

I think you'll find that most countries have very similar systems to the NHS.

But the discussion isn't about the NHS it's about gate keeping.

That Drs retain and excersize the right to decide upon decisions we have made about our bodies, based upon their own personal stance.

The system that exists now, we must each get past that first hurdle, of convincing Drs that we should be permitted to get what we seek.

I find that objectionable.

I suggest that the criteria should be based upon measurable quantities, such as, are we physically fit to survive? Are we mentally competent? So on.

How we pay for it, which is what the likes of state health services, along with private finance, is an entirely separate matter.

Most state funded health services will finance SRS if it is demonstrated to be of long term benefit to the patient.

Quote from: Beverley on April 13, 2012, 05:12:43 PM
Whereas I did it the other way round I saw the therapist first and then told people that I had been diagnosed with a medical condition. This stopped anyone from calling me crazy and for many made it easier to accept what was happening to me because they understood that I was NOT crazy and that this was NOT a choice. It was something that I required treatment for and I was getting the correct treatment.

All I've ever told anyone is, I've felt this way since I was a child and I finally did something about it. No excuses, no telling them it's a "medical condition" that implies it's out of my control. If people think I am crazy, telling them it's a medical condition isn't going to change their mind. The ONLY question anyone asks after I give them my simple explaination is "Are you happy?" I reply yes and they say "Well that's all that matters."

See I don't see it as a medical condition. There isn't anything wrong with being transgendered. I think that is the problem a LOT of transgendered people have is they think they are broken and require fixing. And that this will require some serious professional help!

I transitioned with ZERO help from the medical community. I lived as a woman for several years without one minute of therapy or anything from a doctor. How can wanting to transition be a medical condition if it can be fixed without a doctor? Clearly any body mods will require a doctor and HRT should be monitored by one, but IMHO it's no different than any other cosmetic surgery.

Quote from: Stephe on April 13, 2012, 09:26:42 PM
All I've ever told anyone is, I've felt this way since I was a child and I finally did something about it. No excuses, no telling them it's a "medical condition" that implies it's out of my control. If people think I am crazy, telling them it's a medical condition isn't going to change their mind. The ONLY question anyone asks after I give them my simple explaination is "Are you happy?" I reply yes and they say "Well that's all that matters."

See I don't see it as a medical condition. There isn't anything wrong with being transgendered. I think that is the problem a LOT of transgendered people have is they think they are broken and require fixing. And that this will require some serious professional help!

I transitioned with ZERO help from the medical community. I lived as a woman for several years without one minute of therapy or anything from a doctor. How can wanting to transition be a medical condition if it can be fixed without a doctor? Clearly any body mods will require a doctor and HRT should be monitored by one, but IMHO it's no different than any other cosmetic surgery.

It kinda is, since you don't change all your documentation, pronouns, how you want every other single person to treat you, where you go to do your ablutions and a whole lot of other aspects of your day-to-day life after having a facelift or lyposculpture etc.

However I find this response very interesting. If you don't mind, I have a few questions to try and understand better.

If you didn't see it as something about you which needed fixing... why transition at all? If it was to make you happy, that would surely imply that you were previously unhappy beforehand? If so, why was that?

This is exactly what I was alluding to in the OP when I hit on semantics and context. 

Mentally competent?

Who would you see for that?


A few folks seem hell bent on feeling hyper-persecuted because they're not treated like any other patient seeking run of the mill medical treatment.  I find that a bit odd and a bit surprising.

I get that the stigma of mental illness can be annoying, but at the end of the day...

So what?

How, exactly, is a GID diagnosis as a "condition" different if it is given by a medical as opposed to a mental health professional?

What, exactly, does a GID diagnosis prevent you from doing?  Your name isn't added to some national database, diagnostic information is shared only among your providers.

Does it impact your credit?  Prevent you from buying a house or car? 

I very recently received my diagnosis.  You know what changed?

Absolutely nothing.

My changes and challenges will stem from the actual process of transitioning.  Those same changes and challenges would exist no matter how the "condition of being transgendered" is defined in order to receive proper medical treatment options. 

If you're just pissed off and mortally offended that it currently falls under mental health, fair enough.  Ride that angst for all it's worth.

It seems pretty easy to get so wrapped in being bitter about it that any potential benefits that others may receive, more than a few having been demonstrated as life-saving as the result of mental health being a huge part of the current SoC, stop mattering to you.

That is just sad to me.

-Miki

Quote from: Miki on April 13, 2012, 10:37:01 PM
Does it impact your credit?  Prevent you from buying a house or car? 

I very recently received my diagnosis.  You know what changed?

Absolutely nothing.

It gives credibility to the gross amount of discrimination we face....

The same way that when homosexuality was no longer diagnosed as a mental illness... they were able to start moving forward ...

As long as we remain considered mentally "wrong"... we will continue to be rejected by society at large... and society at large will continue to see us as nothing more than confused men who think they are women.... (because, when you label this a brain defect, that is EXACTLY what you are saying this is... instead of recognizing that people can be of varrying genders without it being a mental illness.... just like, again, the battle that different sexualities had to battle for legitimacy).

You have "Gender Identity Disorder" ...  have you stopped really reading those words? Have you stopped thinking about what that is saying?

Quote from: Rabbit on April 13, 2012, 11:20:59 PM
It gives credibility to the gross amount of discrimination we face....

The same way that when homosexuality was no longer diagnosed as a mental illness... they were able to start moving forward ...

As long as we remain considered mentally "wrong"... we will continue to be rejected by society at large... and society at large will continue to see us as nothing more than confused men who think they are women.... (because, when you label this a brain defect, that is EXACTLY what you are saying this is... instead of recognizing that people can be of varrying genders without it being a mental illness.... just like, again, the battle that different sexualities had to battle for legitimacy).

You have "Gender Identity Disorder" ...  have you stopped really reading those words? Have you stopped thinking about what that is saying?

I appreciate what you're saying here, but on a few levels, could not disagree with you more.

Let me share some perspective around why I started this thread with the concepts of semantics, context and very specific use of language:

Professionally, I provide a significant portion of my clients with policy briefs and position papers on a wide range of issues for legislative consideration.  More than a few of those revolve around health provider policy.  So when I suggest that intentional use of language matters a great deal, it is with first-hand experience on how language evolves from policy concept to legislative proposals, and finally into legislation.


If GID is removed from the burden of any form of medical diagnosis, placing it outside the realm of a medical/mental condition that requires treatment to resolve, it becomes a purely elective endeavor.

It becomes a choice that anyone is free to engage in with no pre-requisites and no qualifiers whatsoever.

That would not break through any discrimination barriers at all.  What it would do is the opposite.

Employers, businesses and other public and private institutions would be able to enact their own standards, just as they do now, without the risk of any discrimination accusations.  Being transgender is now an individual choice, not a recognized condition. 

In the same vein that any employer in a right to work system can create dress-codes, break policies, set working hours, disallow music, smoking, what have you, the onus is on you to conform to those standards. 

There would be no legal burden for them to accept your choice, as you obviously have the freedom to choose not to transition as well. 

What a cluster->-bleeped-<- that would be.

I still think you're confusing the moral aspects of this with the logistical and practical.

Transitioning without a stipulation of necessity, recognition of a medical condition requiring treatment for resolution in the best interest of the health and well being of the patient, would be a horror show.

You would not be a patient anymore, you'd be a customer.  A customer that could be told "no" with no recourse.  Customers want things.  Patients require treatment.

To your last question, of course I've read those words.  I just don't have any problem with them in light of the alternatives available.  Which are exactly non-existent.  If that changes, that would be amazing. 

It has to change smartly, and not in a vacuum, however.  If you were to remove GID as any flavor of diagnosis, as things stand right now, you'd be removing protections against discrimination and denial of care with nothing to replace them with.

After all, if it is just a personal choice, the burden is 100% on you and no government, person, institution or entity has a legal obligation to cater to your choices.

I also have no issues with the disorder label.  If things were "in order" all of this would be moot, no?

-Miki

This is one of those threads that's gonna go no where.

Quote from: Jayr on April 14, 2012, 01:30:47 AM
This is one of those threads that's gonna go no where.

Agreed.

Quote from: Sephirah on April 13, 2012, 09:36:01 PM
If you didn't see it as something about you which needed fixing... why transition at all? If it was to make you happy, that would surely imply that you were previously unhappy beforehand? If so, why was that?

What didn't HAVE to be fixed was the body mods.

What did need to change was the gender I presented to the public. I was a women presenting as a male for way too much of my life.

What was wrong was my way of thinking about my life and what I thought I was required to do. The transition was necessary, fixing my body to be more female is nice but wasn't needed to transition. I think a lot of people see being trans is they are defective/broken, they have to fix their body as best as they can before they can live as their natural gender. I found from personally experience, that isn't required.

Here is one last thought, I notice thousands of trans people who spend tens of thousands on body mods before they feel they are "good enough" to live full time, yet most of them ignore what I consider the most critical to being perceived as a woman "modification", voice therapy. I've read many say "Oh that would be fake" or "That's not my voice"... Try to figure that one out...

Quote from: Miki on April 13, 2012, 10:37:01 PM

What, exactly, does a GID diagnosis prevent you from doing? 

What it prevents me from doing is getting reasonable cost medical insurance in the USA now. It's a question on any application (have you ever been diagnosed with a mental disorder) and as someone who has to buy insurance as a single party, it has a large impact on my acceptance or the rates I am offered. I've actually been turned down twice since I tried to get insurance and the agent said this check box was the reason. They see any "mental disorder" the same, so I'm in the same boat as a paranoid schizophrenic as far as they are concerned.

Quote from: Miki on April 14, 2012, 12:59:22 AM

Employers, businesses and other public and private institutions would be able to enact their own standards, just as they do now, without the risk of any discrimination accusations.  Being transgender is now an individual choice, not a recognized condition. 

Then explain how Gays are included in nondiscrimination clauses with no mental disorder diagnosis? Many places do protect sexual orientation but exclude gender identity still, yet we have this "official disorder".  This disorder diagnosis does not protect us from anything.

Quote from: Rabbit on April 13, 2012, 04:51:03 PM
Maybe this is a cultural thing though... I'm from america... where we value personal freedom.

Ahhhh  the good old days.

The system is set up on the assumption that we are diseased (DSM) therefore we can be fixed. Insurance coverage of treatment for GID is vastly different than, let's say, typical cosmetic surgeries. Here in the US, just about all health insurance polices exclude coverage for any/all gender related treatments. A policy which makes little sense if GID is a recognized health concern.

The medical protocols here are heavily influenced by the lawsuit factor. Tons of unnecessary tests are routinely ordered  just for CYA purposes. A typical court scene with the plaintiffs attorney questioning his expert witness; "Tell me Dr. Howard, If Dr Screwup had ordered the Missleburger Differential Protein test might my client ....." The answer, of course, is always yes, it could have helped, he didn't, therefore he messed up and should be punished. Totally hypothetical but juries buy it and award big paydays.

Now imagine that scene if something goes wrong with a trans person? To about everyone the T person is, and even medically recognized, as being a wacko.Many medical professionals simply refuse to deal with trans patients, no matter what approvals they have.

Quote from: Stephe on April 14, 2012, 10:01:24 AM
...

Then explain how Gays are included in nondiscrimination clauses with no mental disorder diagnosis? Many places do protect sexual orientation but exclude gender identity still, yet we have this "official disorder".  This disorder diagnosis does not protect us from anything.

Being homosexual requires no irreversible surgeries or medical treatment to be gay.  There is no stipulation of necessity at work, as there is no requirement for any prescriptions, surgeries or therapy.  Being gay is not a "resolvable through medical intervention" state of being.  Being gay does not require legal intervention to change official documentation and legal status. 

A diagnosis currently protects you from denial of treatment by defining a condition with a clear treatment path under an existing Standard of Care.  Remove that definition of condition and what you are left with is a personal choice governed entirely by the marketplace and not protected under any right to treatment convention that currently exists.

I'm not advocating that a mental disorder diagnosis is a good thing, or fair, or holds up to any moral argument on principle.  None of those are true.  I'm 100% with you on an informed consent model, and I would much prefer a medical diagnosis as the result of that model with referrals to mental health professionals as needed.  The rub with that is that how many GPs are qualified to identify co-morbid issues?

Would any basis for discrimination actually be reduced if it was solely identified and defined as a medical condition?  I tend to doubt it and stand by the premise that removing any form of diagnosis without a reasonable replacement that afforded protections would throw us back into the dark ages and would actually foster and support more blatant discrimination, not reduce it.


-Miki

- I also respectfully disagree that this thread is going nowhere.  It's actually going to some pretty great places by sharing perspectives and experiences around this, and I'm thankful for that.  I can absolutely disagree with Stephe and Rabbit on things and still respect their opinions and be grateful for them putting them out here. :)

Quote from: Miki on April 14, 2012, 12:59:22 AM
If GID is removed from the burden of any form of medical diagnosis, placing it outside the realm of a medical/mental condition that requires treatment to resolve, it becomes a purely elective endeavor.

This is more of an issue with the way health care is handled than anything else... and I think everyone would agree the way health care is handled is a major issue.

Saying we NEED to be labeled and thought of as mentally disturbed so we can fit into a broken healthcare system is... silly.

You think this is only an issue that exists in the doctors office? That when we step outside of the house, the general population doesn't shrink away because we are "mentally ill" and "confused"? I'm sorry, but the idea that being transgendered is a mental defect is a large contributing factor to how society sees us (or perhaps, it is a reflection of the way society sees us).

I'm not sick. I'm not crazy. I simply have a gender identity which falls within the normal range for humans.

Just as homosexuals are not sick, they are not crazy... they simply have a sexual identity which falls within the normal range for humans.

How is this such a hard concept? That we are normal?

Other societies have managed to figure out that the variation of gender identity was a normal thing for people... they even believe that it wasn't a NEGATIVE, but it was a positive... because the transgendered person seemed to understand so much more than a normal person.

Quote from: Miki on April 14, 2012, 11:57:11 AM
Being homosexual requires no irreversible surgeries or medical treatment to be gay.

Neither does being transgendered. People choose to have these. As witnessed by the millions of closeted transgendered people, you can choose to do nothing. I did nothing for 45 years. I then fully transitioned into life as a woman and lived as one for several years without any irreversible surgeries or medical treatment.

Quote from: Miki on April 14, 2012, 11:57:11 AM
There is no stipulation of necessity at work, as there is no requirement for any prescriptions, surgeries or therapy.  Being gay is not a "resolvable through medical intervention" state of being.

Neither is being transgendered. Again people choose to have these and IMHO being trans isn't "resolved through medical intervention" but that's a whole nuther can of worms I'm not opening here. I suppose you could "resolve" being gay with an orchi or meds that would kill their sex drive....

Quote from: Miki on April 14, 2012, 11:57:11 AM
Being gay does not require legal intervention to change official documentation and legal status.

I feel between the SOC and the fear of gay marriage is why in the US most states require surgery. That's a failure of the law and GID diagnosis doesn't make this better or worse. If I could get the sex marker changed after I was diagnosed with GID I might feel slightly differently about it.  Also notice being Gay means you can never get married in the present state of thing in the US.

Quote from: Miki on April 14, 2012, 11:57:11 AM
A diagnosis currently protects you from denial of treatment by defining a condition with a clear treatment path under an existing Standard of Care.  Remove that definition of condition and what you are left with is a personal choice governed entirely by the marketplace and not protected under any right to treatment convention that currently exists.

I have zero fear of doctors getting out of this marketplace. Witness all the FFS doctors who are not being mandated to provide these services.

Quote from: Miki on April 14, 2012, 11:57:11 AM
I'm not advocating that a mental disorder diagnosis is a good thing, or fair, or holds up to any moral argument on principle.  None of those are true.  I'm 100% with you on an informed consent model, and I would much prefer a medical diagnosis as the result of that model with referrals to mental health professionals as needed.  The rub with that is that how many GPs are qualified to identify co-morbid issues?

Would any basis for discrimination actually be reduced if it was solely identified and defined as a medical condition?  I tend to doubt it and stand by the premise that removing any form of diagnosis without a reasonable replacement that afforded protections would throw us back into the dark ages and would actually foster and support more blatant discrimination, not reduce it.

I don't see any "reduction in discrimination" that has this mental disorder thing as a basis right now. There is nothing in any law that says you can't discriminate against someone because they have a mental disorder. I fail to see what protection we get from this.

Quote from: Jayr on April 14, 2012, 01:30:47 AM
This is one of those threads that's gonna go no where.

  Yeah i've found trying to get your point across over the internet is in fact kind of pointless. You can't post anything without hurting or offending someone no matter how well you word it. It's just like an endless cycle of "i'm right your wrong" attitudes. I try to stay out of these sort of threads when ever possible, it's a waste of time.

  I have a headache from reading the walls upon walls of text.  :icon_neutral: 

Stephe, Rabbit, I think we've gotten to that place where the whole "respectfully agree to disagree" thing comes into play.

Thanks for the civil back and forth, and thank you both for for sharing your honest take and your personal experiences around this issue. 

There's a lot of nuance involved and I honestly respect and appreciate the perspectives you've both shared. :)




As for causing other folks headaches, my sincere apologies if this somewhat complex issue not being watered down into lowest common denominator platitudes and politically correct TG talking points has been problematic reading. 

I honestly think, "I'm right, you're wrong" has been deftly avoided in this thread in favor of the clarification of passionate viewpoints and opinions while not being offensive.

I think that is never a bad thing on a forum dedicated to that exact purpose.

Thanks :)

-Miki

Quote from: Stephe on April 14, 2012, 10:01:24 AM
What it prevents me from doing is getting reasonable cost medical insurance in the USA now....

It is my understanding that one of the real benefits of the upcoming health care reform in the US (a.k.a. 'obamacare') for trans people is that we can no longer be refused care under pre-existing condition exclusions.

Things are going to be changing drastically over the next few years, I think. The new WPATH SOC include and encourage informed consent for hormone access. The US govt has said that gender markers on passports can be changed without a specific requirement for medical transition, either hormones or surgery. More US states are changing driver's licenses to be updated based on primary care dr (or other providers) attestation of lived gender consistency. The next DSM has some significant changes removing binary identity requirements for trans people. More insurance companies are covering trans care, including SRS. And the ICD-10, the international healthcare coding structure, is itself being revised. Not all of these documents and policies agree, by any means. But the stranglehold that the DSM has had is loosening, and a new generation of medical and mental health providers is coming on the scene.

Quote from: MrTesto on April 14, 2012, 11:11:50 PM
It is my understanding that one of the real benefits of the upcoming health care reform in the US (a.k.a. 'obamacare') for trans people is that we can no longer be refused care under pre-existing condition exclusions.

Unfortunately, this doesn't mean that we can get insurance at affordable rates on individual plans.

For example, I applied for an individual plan hoping to pay in the range of 100 - 150 a month. I was rejected because "current medications, and planned or expected surgery". Insurance is a business looking to turn a profit after all. They're going to have to charge you more than what they expect to pay out in order to accept you. And currently, with tests, doctors visits, and HRT, I'm paying roughly 200 a month.

If you get lucky and get an employer that offers a health plan that covers transsexualism, that's a different story I guess...

Quote from: Alainaluvsu on April 14, 2012, 11:48:37 PM
Unfortunately, this doesn't mean that we can get insurance at affordable rates on individual plans....

That's very true. If the national model follows the way it is in Massachusetts, however, there may be some better news. The plans for formerly-uninsured, and low income residents tend to have decent actual coverage for blood work and hormones, even while there are often explicit exclusions. I was not a big fan of being forced to buy insurance, but it seems to be working out better than I had thought it would.

It's commonly that way with employer-sponsored plans, too (exclusions, and yet coverage), even when it's clear that a person is transitioning. I don't understand why it happens that way, and because it's an exclusion, it's hard to advocate on a mass scale without shining a spotlight where people are actually getting needed services.

Quote from: Miki on April 14, 2012, 10:33:04 PM
As for causing other folks headaches, my sincere apologies if this somewhat complex issue not being watered down into lowest common denominator platitudes and politically correct TG talking points has been problematic reading.

-Miki

It's not really that complex, gatekeeping has it's pro's and con's. You guys are just making a mountain out of a mole hill.  :)

Quote from: MrTesto on April 14, 2012, 11:11:50 PM
It is my understanding that one of the real benefits of the upcoming health care reform in the US (a.k.a. 'obamacare') for trans people is that we can no longer be refused care under pre-existing condition exclusions.

Things are going to be changing drastically over the next few years, I think. The new WPATH SOC include and encourage informed consent for hormone access. The US govt has said that gender markers on passports can be changed without a specific requirement for medical transition, either hormones or surgery. More US states are changing driver's licenses to be updated based on primary care dr (or other providers) attestation of lived gender consistency. The next DSM has some significant changes removing binary identity requirements for trans people. More insurance companies are covering trans care, including SRS. And the ICD-10, the international healthcare coding structure, is itself being revised. Not all of these documents and policies agree, by any means. But the stranglehold that the DSM has had is loosening, and a new generation of medical and mental health providers is coming on the scene.

I just hope this health care reform doesn't get crushed before it ever takes effect... The insurance companies are still pushing to get it repealed as it would force them to be fair.

On your other points, I have read the newest version of the DSM and like the direction it is headed. I really make an effort to make things easier for future generations of trans people and feel I have made a dent in this, at least where I live. I think if this gay marriage thing can be federal law, a lot of these gender marker holdouts will give in being its a moot point as far as blocked "gays claiming to change sex so they can marry" mindset.

Quote from: MacKenzie on April 15, 2012, 12:08:40 AM
It's not really that complex, gatekeeping has it's pro's and con's. You guys are just making a mountain out of a mole hill.  :)

I can assume then you've never been beaten about the head by it..

I'd rather have a guide than a gatekeeper.  I feel like gate keeping is unethical to a certain extent: the medical professional has the ability to ease the mental and emotional suffering of an individual, but won't until certain arbitrary criteria are met.  If I had a malignant tumor, I would sign a paper and have it removed.  If my testes are secreting a hormone that has effects which cause me mental and emotional distress, I should be able to sign a paper and have them removed(after appropriate education is given to the individual).  I'm an advocate of informed consent, but completely understand why some medical professionals wouldn't put themselves out there in such a fashion and favor what is commonly referred to as "gatekeeping."