Susan's Place Transgender Resources

I've seen quite a few posts from members reminding people that living as the chosen gender for over a year is a requirement for gender confirming surgeries, but that was a while ago at least in the U.S. I thought the Real Life Test was deemed inhumane when it was part of HBIGDA before it became WPATH. Soooo, am I wrong or something? I know there are surgeons in the states willing to operate on 16yr old and older kids with parent approval as well as waiving part of the letter requirement on a case by case basis. It just seems odd that people keep saying something I'm positive isn't true where I live.....


     Hugs,
- Katie
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Yup, still a thing unfortunately.  It's the only thing holding me back from surgery right now, so it's a bit of a raw point with me.  I have everything else in place - letters, the whole lot - but god forbid I haven't strutted around as a full-time female for an entire year...

I do see the upside of it; GRS is a huge change, and at least knowing what one is getting into from a societal standpoint is important.  But given that GRS is just about the one change in our entire transitions that can be kept entirely private (hormones are on public display, name changes too, clothing, etc.), I don't see the need for an entire year of 100% proven RLE.  I'd much prefer this to be rolled into the psych letters for surgery with a paragraph about how the patient has demonstrated full awareness of the magnitude of the surgical changes and has demonstrated the means to accommodate those changes into his or her life.

I've been part time for a long time, and 90% full time for a long time too.  In total, waaaay more than a year.  I've almost been full time 100% (like, literally emptying my life of everything male) for a year, so that hurdle will be jumped over soon enough.

Unlikely to change anytime soon though.  But at least it's not going back to the really bad old days when RLE was a prerequisite for hormones.

Here's what's written in my WPATH V7:

QuoteCriteria for metoidioplasty or phalloplasty in FtM patients and for vaginoplasty in MtF patients:

1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless
hormones are not clinically indicated for the individual).
6. 12 continuous months of living in a gender role that is congruent with their gender identity.

Pretty much all the decent, reputable GRS surgeons also require the one year RLE too, although how they want this documented seems vague.

It's certainly still in the WPATH standards of care, and surgeons still require two letters. Is it possible to get two letters without doing RLE? Probably, if you shopped around a bit.

If you think about it there probably are ways around the RLE. But I personally believe that it is a good thing. It gives potential transitioning folks and their doctors that last boundry for them to make a really serious decision. I disaprove of that it goes for such a lengthly period though. It is too long.

Quote from: suzifrommd on September 13, 2015, 08:55:10 AM
It's certainly still in the WPATH standards of care, and surgeons still require two letters. Is it possible to get two letters without doing RLE? Probably, if you shopped around a bit.

This is going to show how old fashioned I am, but, I believe that there was once a fast track approach in the standards for people who have already been living full time for a long time and just wanted to come in and get the surgery. It used to be that many would take street hormones and live as women for years until they could finally afford to get surgery. Nowadays I believe that the medical profession is a little more in tune with the world and this might be dying off in more advanced countries but still the norm in 3rd world countries.

It's no longer RLT, it's RLE. No "test", just a specific length of experience living in your correct gender. If mental health folks were sensible, they'd get to know you and see if it makes sense as far as your goals go. That is basically what the therapist who wrote my top surgery referral did, and he has said that he would do the same whenever I felt I was ready for bottom surgery.

I really don't think I had an "RLT' or "RLE". I always dressed up like a guy, my mannerisms were always pretty masculine. I had a few sessions with my Gender Therapist and on my last one before she gave me my letter to start hormones she took me to a Starbucks and treated me because I helped her get those water fountain jugs for the office. I guess that was my "RLT" haha. She deemed me a true gentleman :P

My top surgeon told me I could get a letter from my endo and that would be enough for me to go forward with. So I got that very easily and was able to have my surgery in July.

I think the RLE is good because it allows one to grow into being whatever their gender is and gives time for issues like family, job and other stuff to be sorted out.

I think I read on some post on here that a legal name change was accepted as legal documentation as having started RLE. So, for anyone starting out... I guess getting a name change somewhat early on wouldn't be a bad idea since legally speaking, even if you presented as male (or female if you're FtM) then it'd legally count.

You might check in your area and see if that's the case.

I have an intense dislike of RLT and its caused me a great deal of anguish. Doing RLT would likely turn my life upside and I don't feel a strong need to present female. I do feel some need for SRS on the other hand.

Quote from: StartingOver on September 13, 2015, 06:21:01 AM
Yup, still a thing unfortunately.  It's the only thing holding me back from surgery right now, so it's a bit of a raw point with me.  I have everything else in place - letters, the whole lot - but god forbid I haven't strutted around as a full-time female for an entire year...

If you have the letters have you tried asking the surgeon if he'll accept them? My understanding is that most of them don't care about anything except you having the letters. They are not qualified to evaluate you and its not their job. On top of that, like HRT, these letters are not a legal requirement and the surgeon can accept whatever they want, including no letters at all.

A lot of surgeons have a really long waiting list and my favorite, Suporn, is close to a year. You might end up doing a year of RLE anyway if you've not booked already.

Quote from: ftmax on September 13, 2015, 09:45:04 AM
It's no longer RLT, it's RLE. No "test", just a specific length of experience living in your correct gender. If mental health folks were sensible, they'd get to know you and see if it makes sense as far as your goals go. That is basically what the therapist who wrote my top surgery referral did, and he has said that he would do the same whenever I felt I was ready for bottom surgery.

I believe the technically correct term is RLT and and politically correct term is RLE. If you don't serve out your year then you don't get the letter, which makes it a test in my mind.

Quote from: StartingOver on September 13, 2015, 06:21:01 AM
Yup, still a thing unfortunately.  It's the only thing holding me back from surgery right now, so it's a bit of a raw point with me.  I have everything else in place - letters, the whole lot - but god forbid I haven't strutted around as a full-time female for an entire year...

I do see the upside of it; GRS is a huge change, and at least knowing what one is getting into from a societal standpoint is important.  But given that GRS is just about the one change in our entire transitions that can be kept entirely private (hormones are on public display, name changes too, clothing, etc.), I don't see the need for an entire year of 100% proven RLE.  I'd much prefer this to be rolled into the psych letters for surgery with a paragraph about how the patient has demonstrated full awareness of the magnitude of the surgical changes and has demonstrated the means to accommodate those changes into his or her life.

I've been part time for a long time, and 90% full time for a long time too.  In total, waaaay more than a year.  I've almost been full time 100% (like, literally emptying my life of everything male) for a year, so that hurdle will be jumped over soon enough.

Unlikely to change anytime soon though.  But at least it's not going back to the really bad old days when RLE was a prerequisite for hormones.

Here's what's written in my WPATH V7:

Pretty much all the decent, reputable GRS surgeons also require the one year RLE too, although how they want this documented seems vague.

Yeah the how it's documented part really annoys me. I've been living "as the gender role that is congruent with my gender identity" for more than three years now but I haven't made any official documentation of it. I'm calling my psych monday to schedule an appointment for my first letter so I guess I'll find out then.

Quote from: Lady_Oracle on September 13, 2015, 04:38:28 PM
Yeah the how it's documented part really annoys me. I've been living "as the gender role that is congruent with my gender identity" for more than three years now but I haven't made any official documentation of it. I'm calling my psych monday to schedule an appointment for my first letter so I guess I'll find out then.

I guess i figured that because it is literally impossible to document a year's worth of living in your chosen gender, that that aspect of the WPATH requirements was fudgeable. I know that while it isn't recommended, you can transition in stealth, and I was under the impression that the documented transition time was used as the hard and fast 1yr rule, i.e. if you started medical transition 6 months ago, surgeons would prefer to wait until you are further along the process so they don't risk performing surgery on someone who might choose to detransition.

I guess I just didn't realize this was a concrete rule some of y'all had to deal with, since I'm only worried about spending too many years on spiro and hurting my liver before I have time for my surgery and recovery.

Quote from: Obfuskatie on September 13, 2015, 05:55:42 PM
I guess i figured that because it is literally impossible to document a year's worth of living in your chosen gender, that that aspect of the WPATH requirements was fudgeable. I know that while it isn't recommended, you can transition in stealth, and I was under the impression that the documented transition time was used as the hard and fast 1yr rule, i.e. if you started medical transition 6 months ago, surgeons would prefer to wait until you are further along the process so they don't risk performing surgery on someone who might choose to detransition.

I guess I just didn't realize this was a concrete rule some of y'all had to deal with, since I'm only worried about spending too many years on spiro and hurting my liver before I have time for my surgery and recovery.

Yep like that's my concern too, I'm on a high dose of spiro and would like to get off it sooner than later. I can't stand the side effects minus the t being blocked lolol. I have been on hrt for 3.5 years now so I definitely pass that one year rule. I guess I don't have much to worry about honestly. Once my psych sees me she'll probably give me my letter immediately just like she did for hrt. I didn't even get a letter to start hrt, she made a phone call to my endo and that was it. There's more to that story but yeah by the time I saw a psych I was already two years into my transition and she saw that I had already worked through the coming out stuff and the early transition stuff too so I was more than ready to start hrt, just like I'm more than ready for grs.

Here's a YouTube video about getting SRS letters in Sydney. One psych session.

Transgender SRS Psychiatrist visit for APPROVAL! Australia , by Jacinta Andrews
https://www.youtube.com/watch?v=mO3WsPaeQJI

From her previous video's I think this is Dr Michael Scott of Neutral Bay.

I will never understand why this is a controversy.  It's a year.  Do you realize how fast that goes by? Wouldn't you want to take a year anyway to make sure living in your new gender role actually fits you before doing something that can't be reversed?

Yeah in the grand scheme of things, a year isn't much time but for some that could be an eternity. Idk my heart goes out to non binary folks. I'm a part of the binary so the psych evaluations and stuff aren't difficult since I fit the "criteria"

I do wonder if it's something I will be asked to do.

Short of gluing on a fake 'tache and telling everyone to call me sir I can't see how my regular life could be any different living as male in RLE. Seriously, I've been living this way for half a decade, I wonder what on earth I could do to make it any more "real". 

I don't think that cisgender people know best about the needs of transpeople at all.  They have created a one-size-fits-all solution for a problem that is unique to all of those who suffer it.  Some people probably should do a year (or even several years) of this before committing to irreversible surgery, but I think it should me merely a suggestion. 

My body. My rules. 

I just don't understand exactly what they mean by "living in role". is it just name change, asking people to use your correct pronouns and making an effort to pass? Or will they look for gender specific hobbies or whatever?

I don't think I'll ever pass without hormones or top surgery, and if i can't get those if i don't pass, then what am i meant to do?

I'm a little confused too.
Is RLE required for both HRT and surgeries? Or just surgeries only?

If RLE is required for hormones, then how does one prove that they're living as the other gender for an entire year? Just by name changes and that's it?

I'm confused here,most transgender wants srs but not wanting too live in the gender roles they want too be.I agree with rle it gives one a perspective of what being in gender is actually like. If you want to be a woman be a woman ,if you want too be a man be a man,don't hide live.

The problem is that good surgeons will want to see the letters and the RLE, before booking.  With some of them having wait times from 1-2 years for surgery, that could mean waiting up to 3 years in some cases.  It adds up.

I would like a better understanding of what constitutes the start of RLE.  Is it the start of HRT, the legal name change or being full time?  For me those are very different dates.

I think Cheryl has a point. RLE is supposed to make sure you know what living in a role of a man or woman is like, because formerly most trans people have lived in the opposite role and been treated as the opposite gender.. perhaps they do not know yet what that experience will be like at all and if they can deal with it. It's one thing to say you wished to be another gender, but another to understand how that gender is treated. I know from observations and a lot of reading and exploration that men and women are treated very differently. In some ways subtle and in other ways blatant.

But short of admitting to everyone around you that you wish to be treated like the other gender, how exactly do you create the conditions for RLE, particularly if you do not pass well before any sort of transition? You can dress like the target gender, act like the target gender, but unless everyone around you also plays along, how do you gain that authentic experience until you transition...?

I dress and act like the target gender but I do not feel it would be even remotely appropriate to tell everyone around me to start treating me like a man yet. I do not look like one yet.

What i don't understand is that nothing i do day to day that doesn't related to my actual physical body functions (like washing my breasts or having my period) is female specific (I'm ftm) so what am i going to change? I don't really understand what is meant by 'role'. I understand presenting as male (i.e. preferred pronouns/ name change/ fashion choices/ using the mens room). Are they just the same thing?

Because I don't want to be "treated as male" if that means having to regress by fifty years of "gender role" standards

Hello Everyone, it was very difficult if not impossible to view myself as female so long I still had a penis.
How could I be to expected live full time when I was male under the skirt!

So here is how I survived or got around the RLT 'guidelines' and underwent expedited SRS in 10 months.

• Came out as transsexual to my then wife in late July of 2014.
• Told psychiatrist (via insurance coverage) I was seeking SRS not necessarily HRT. (VERY IMPORTANT!)
• Legal name and gender change.
• All identity documents changed.
• Informed family members I was a transsexual woman.
• Sent deposit for SRS with Dr. Marci Bowers.
• Scheduled consultation with Dr. Tody Meltzer of Arizona.
• Started presenting at work as a woman.
• Documented (video) proof I was trying to play ball (live as a woman).
• Participated in community geared events (transgender).
• Inundate therapists with pictures of me in public (Twitter account).
• Became a pain in the butt to same therapists.
• Became very argumentative about the SRS guidelines (they are only guidelines, not rules).
• Started the ouch process of genital electrolysis. (Very important, demonstrated sincerity).
• Agreed to play ball with one therapist and continue to see a third right up until SRS date.
• Received my two SRS letters.
• Narrowed down SRS surgeons to Greater Los Angeles area only.
• Cash deal despite having insurance.
• Green light from Endo.
• Green light from 2nd Endo (via insurance).
• Pleaded my case to SRS surgeon of choice.Told him I plan to use 'it' (neo-vagina) for intercourse.
• Greenlighted for SRS by my general practitioner (GP).
• Underwent SRS in mid May of 2015.

Living happily as female and enjoying the real 'Real Life Experience'.
Yes, its awesome, I highly recommend it!
Thank you,
Anne

Quote from: cheryl reeves on October 21, 2015, 10:19:44 PM
I'm confused here,most transgender wants srs but not wanting too live in the gender roles they want too be.I agree with rle it gives one a perspective of what being in gender is actually like. If you want to be a woman be a woman ,if you want too be a man be a man,don't hide live.

I find life a bit more complicated than that. I need to remain married and provide for my family. I don't think I can fully transition and continue to do that, and I also probably can't keep my sanity without doing something. When it gets right down to it if getting SRS without ever presenting female keeps everything together then that's what I'll do. I guess you can say I've done my RLT for decades.

I know about rle,I live everyday like I have for 50 years trapped between genders,I just learned too be the best me as I can get. I'm a weird one I chose along time ago too face life head on and anyone who got in my way learned to go along for the ride or get off the bus. I chose not too transition for my own reasons. What gets me though is bulking about living the gender role before surgery,they make prosthesis nowadays too help give the idea of what life is going too be like before surgery,so to make sure your not making a rash decision and regret it later,I've read the stories and the obituaries and my heart breaks.

Quote from: Lady_Oracle on September 13, 2015, 04:38:28 PM
Yeah the how it's documented part really annoys me. I've been living "as the gender role that is congruent with my gender identity" for more than three years now but I haven't made any official documentation of it. I'm calling my psych monday to schedule an appointment for my first letter so I guess I'll find out then.

If you don't mind, please post what happens.  I'm very interested in whether I'll have to live 100% as male to get top surgery.  Not that I mind living as a male its just who's to say what level of "living as a male" matches anyone's dysphoria?  What about those who are non binary?

I agree with the reason for RLT/RLE particularly for those who have lived for many years in their birth gender. Being treated as the opposite gender, if you have grown up with 'male privilege' or, in the case of FtM, realizing what is expected of you can come as quite a shock. It is a time to find out what everyday life will be like while you  can still switch back.

Quote from: chance on October 26, 2015, 04:36:04 AM
If you don't mind, please post what happens.  I'm very interested in whether I'll have to live 100% as male to get top surgery.  Not that I mind living as a male its just who's to say what level of "living as a male" matches anyone's dysphoria?  What about those who are non binary?

TIME FOR UPDATE  :D I come with good news. I think as long as you're out to the people closest to you and or you present consistently as the gender you're transitioning to plus also being on hrt, you've done all of that for more than year then you pass the rle i think for surgery. As far as being non binary, I have no idea honestly. I don't think none of the well known surgeons will operate on anyone who hasn't at least been a year on hrt.

I had my session and like it went exactly the way I thought it would. She signed off after the first session, was happy to write my letter. I hadn't seen her since I started hrt. I explained to her in full detail how much my bottom dysphoria has been affecting my life from my relationships to how I feel about my own body and just the havoc it's been causing on my self esteem/body image. I stated that I've had the legal stuff done, name change/gender marker. I've been doing my research on surgery for a long time now and so like I know exactly what the consequences are if things go wrong and what to expect, which I explained to her. I went into detail about how my want for surgery became a need the further I went into my transition. I talked about the odd disconnect I've always felt with myself down there. She did help me realize its not so much that I feel wrong down there, its that I feel like something is missing.

As to why she signed off so quickly, I think it's due to a few reasons:
1. I have a very strong support system. My parents and family fully support me and have been funding my transition.
2. I'm absolutely secure in my gender, like detransitioning hasn't ever been something I've considered since starting 5 years ago. I don't have doubts about whether or not surgery is the right choice. However I did explain to her that I had doubts at one point and how I overcame those doubts.
3. I've been full time for more than 2 years.

Quote from: Lady_Oracle on October 26, 2015, 07:26:10 AM
TIME FOR UPDATE  :D I come with good news. I think as long as you're out to the people closest to you and or you present consistently as the gender you're transitioning to plus also being on hrt, you've done all of that for more than year then you pass the rle i think for surgery. As far as being non binary, I have no idea honestly. I don't think none of the well known surgeons will operate on anyone who hasn't at least been a year on hrt.

I had my session and like it went exactly the way I thought it would. She signed off after the first session, was happy to write my letter. I hadn't seen her since I started hrt. I explained to her in full detail how much my bottom dysphoria has been affecting my life from my relationships to how I feel about my own body...

Thanks for the update Lady Oracle. I appreciate it. I'm trying to consider what it might be like when I Fodor my letter.


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Quote from: Northern Jane on October 26, 2015, 07:03:56 AM
I agree with the reason for RLT/RLE particularly for those who have lived for many years in their birth gender. Being treated as the opposite gender, if you have grown up with 'male privilege' or, in the case of FtM, realizing what is expected of you can come as quite a shock. It is a time to find out what everyday life will be like while you  can still switch back.

Switching back isn't something I was capable of. I was barely able to manage presenting as a guy. I guess I didn't really think about the rest of the WPATH stuff, because I've always been focused on the next few months to a year ahead. I guess I thought people were talking about RLE before any HRT.
There's still a part of me that is very indignant that I have to justify and prove myself for the joy of being trans. But if I let myself get distracted by the relatively small hoops I have to go through, I won't be enjoying the very freeing aspects of transition.


     Hugs,
- Katie
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Quote from: Obfuskatie on October 27, 2015, 06:07:05 AM
I guess I thought people were talking about RLE before any HRT.

From what I've read the NHS requires RLE before HRT? I could be wrong

Quote from: Peep on October 27, 2015, 02:29:42 PM
From what I've read the NHS requires RLE before HRT? I could be wrong

Yep, you are wrong. Current NHS
guidelines do not require RLE before hormones.

Quote from: kelly_aus on October 27, 2015, 04:07:58 PM
Yep, you are wrong. Current NHS
guidelines do not require RLE before hormones.

Do you have a source i could read?

Quote from: Peep on October 27, 2015, 05:05:38 PM
Do you have a source i could read?

It was the NHS site.. I'll find it again when I'm on my PC.

Quote from: Lady_Oracle on October 26, 2015, 07:26:10 AM
2. I'm absolutely secure in my gender, like detransitioning hasn't ever been something I've considered since starting 5 years ago. I don't have doubts about whether or not surgery is the right choice. However I did explain to her that I had doubts at one point and how I overcame those doubts.
3. I've been full time for more than 2 years.

At 5 years RLE you really don't need therapist sign off.

Quote from: kelly_aus on October 27, 2015, 04:07:58 PM
Yep, you are wrong. Current NHS
guidelines do not require RLE before hormones.

It may not be a requirement anymore but they're still not so willing to prescribe hormones before RLE.

Quote from: iKate on October 28, 2015, 09:02:06 AM
At 5 years RLE you really don't need therapist sign off.

Yeah but it wasn't officially documented. I didn't see a psychiatrist till I started hrt, which was two years in.

Like I said before what is wrong with rle? I personally think the transitioner should know what they are getting into before there is no way back. I know prosthetics are expensive but they help you get a feel of what its going too be like all the time.

One of my relatives was just approved on NHS for hormones and is probably receiving them by now. Far as I know, no RLE was required, just 3 previous sessions with a psych evaluator and a doctor.

Quote from: cheryl reeves on October 29, 2015, 01:16:35 AM
Like I said before what is wrong with rle? I personally think the transitioner should know what they are getting into before there is no way back. I know prosthetics are expensive but they help you get a feel of what its going too be like all the time.

For you nothing, for me everything.

Quote from: Obfuskatie on September 13, 2015, 05:55:42 PM
I guess i figured that because it is literally impossible to document a year's worth of living in your chosen gender, that that aspect of the WPATH requirements was fudgeable. I know that while it isn't recommended, you can transition in stealth, and I was under the impression that the documented transition time was used as the hard and fast 1yr rule, i.e. if you started medical transition 6 months ago, surgeons would prefer to wait until you are further along the process so they don't risk performing surgery on someone who might choose to detransition.

I guess I just didn't realize this was a concrete rule some of y'all had to deal with, since I'm only worried about spending too many years on spiro and hurting my liver before I have time for my surgery and recovery.

I am a retired physician. I feel really strongly about this as I think it is a boundary issue. In sum: it is my life and my body. Period. If I am competent and have, with my doctor, determined that GRS is appropriate then a referral to the surgeon should be made. I would hope that my physician would ask me about my comfort in living as my chosen gender, find out what my therapist thought, and spend some time in helping formulate an opinion. If this all seemed well reasoned and there were no contraindications, the year period is simply arbitrary. I suspect that there is nothing in the literature that proves that 365 days is a golden standard. My body and its modification is the focal point and ground zero for enough in this journey. Why make rigid standards another battleground? Just my opinion. Sheila Grace

Quote from: Sheila Grace on October 29, 2015, 09:22:02 AM
I am a retired physician. I feel really strongly about this as I think it is a boundary issue. In sum: it is my life and my body. Period. If I am competent and have, with my doctor, determined that GRS is appropriate then a referral to the surgeon should be made. I would hope that my physician would ask me about my comfort in living as my chosen gender, find out what my therapist thought, and spend some time in helping formulate an opinion. If this all seemed well reasoned and there were no contraindications, the year period is simply arbitrary. I suspect that there is nothing in the literature that proves that 365 days is a golden standard. My body and its modification is the focal point and ground zero for enough in this journey. Why make rigid standards another battleground? Just my opinion. Sheila Grace

I think it's partially that they just want to do a little legal CYA for their own malpractice premiums, and partly that all surgeons especially plastic are relatively focused on results and keeping their batting average high as it were. It makes sense to me at least to have many of these hoops in order to regulate all sorts of surgeries. I think the problem is that many Cis people think of GCS as non essential. Whether they are trying to help or hinder the process, it's relatively difficult to get everything done in a FUBU kind of way.


     Hugs,
- Katie
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Quote from: Sheila Grace on October 29, 2015, 09:22:02 AM
I am a retired physician. I feel really strongly about this as I think it is a boundary issue. In sum: it is my life and my body. Period. If I am competent and have, with my doctor, determined that GRS is appropriate then a referral to the surgeon should be made. I would hope that my physician would ask me about my comfort in living as my chosen gender, find out what my therapist thought, and spend some time in helping formulate an opinion. If this all seemed well reasoned and there were no contraindications, the year period is simply arbitrary. I suspect that there is nothing in the literature that proves that 365 days is a golden standard. My body and its modification is the focal point and ground zero for enough in this journey. Why make rigid standards another battleground? Just my opinion. Sheila Grace

I totally agree, and there are doctors that do as well. Its just a matter of finding them.

I don't think it's actually possible to experience what it will be like post chest surgery and hormones until it actually happens. I'm not passable at all, even with my chest bound, so how is RLE going to help? It won't be experiencing the world as male, just as feminine andro or as hideously visible trans. Or, as a butch lesbian, which is what people assume. There's no way I feel confident using a mens room yet, pre HRT. It always feels like scare tactics to me.

Quote from: AnonyMs on October 29, 2015, 08:49:01 AM
For you nothing, for me everything.

The way I think is the problem I see with rle is that it is expecting that everyone wants the exact same transition.  To transition into a narrowly defined version of what a male or female must be like.  And that doesn't cover all of the genders that actually exist imho.


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Quote from: Lady_Oracle on October 29, 2015, 12:21:07 AM
Yeah but it wasn't officially documented. I didn't see a psychiatrist till I started hrt, which was two years in.

Hormones doesn't mean RLE. You can be taking hormones and presenting male. Mental health treatment isn't a requirement to go full time either. You can do informed consent or even self medicate.

I've been talking to some surgeons offices and they say the guidelines for them are not set in stone, but they have to adhere to them due to insurance coverage.

But if you can prove 5 years RLE, you will likely be approved.

Quote from: Sheila Grace on October 29, 2015, 09:22:02 AM
I am a retired physician. I feel really strongly about this as I think it is a boundary issue. In sum: it is my life and my body. Period. If I am competent and have, with my doctor, determined that GRS is appropriate then a referral to the surgeon should be made. I would hope that my physician would ask me about my comfort in living as my chosen gender, find out what my therapist thought, and spend some time in helping formulate an opinion. If this all seemed well reasoned and there were no contraindications, the year period is simply arbitrary. I suspect that there is nothing in the literature that proves that 365 days is a golden standard. My body and its modification is the focal point and ground zero for enough in this journey. Why make rigid standards another battleground? Just my opinion. Sheila Grace

Dr Marci Bowers says she disagrees like you do but has to go along with it for insurance coverage reasons.

My view is that unless you have intense genital dysphoria and/or want to be sexually active, holding off a year is no real big deal. But again, I'd the above two apply to you I can see how you'd want to move as quickly as possible.

I'm not trying too cause any problems,but I still can't wrap my head around why so many transgender bulk at rle. If you live your life as male or female and want too transition wouldn't you like too know what your getting into,instead of jumping into the deep end without testing the waters? I've known a few cders who decided they were transsexual and jumped without first testing the waters,then found they should have tested the water first,one wanted too transition back,the other was kinda withdrawn after.  Sure it's your body but wouldn't you want too know what your getting into?

Quote from: cheryl reeves on October 31, 2015, 12:13:47 PM
I'm not trying too cause any problems,but I still can't wrap my head around why so many transgender bulk at rle. If you live your life as male or female and want too transition wouldn't you like too know what your getting into,instead of jumping into the deep end without testing the waters? I've known a few cders who decided they were transsexual and jumped without first testing the waters,then found they should have tested the water first,one wanted too transition back,the other was kinda withdrawn after.  Sure it's your body but wouldn't you want too know what your getting into?

I may be a bit unusual, but I'm trying not to transition and only doing as little as possible to keep my sanity. Social transition is the last thing I'm going to do after trying everything else, including SRS. It doesn't matter if I don't know what RLE is like, because I'm doing it the other way around. If I finally get to it and RLE works out badly I'm in big trouble as there's nothing else left.

It may not be a good idea, but its what I choose. I do have a few reasons that make sense to me.

Quote from: cheryl reeves on October 31, 2015, 12:13:47 PM
I'm not trying too cause any problems,but I still can't wrap my head around why so many transgender bulk at rle. If you live your life as male or female and want too transition wouldn't you like too know what your getting into,instead of jumping into the deep end without testing the waters? I've known a few cders who decided they were transsexual and jumped without first testing the waters,then found they should have tested the water first,one wanted too transition back,the other was kinda withdrawn after.  Sure it's your body but wouldn't you want too know what your getting into?

How does RLE let you know this?

Unless you're transitioning in the sense of a complete, traditional, outdated gender binary switch, and unless you can actually pass, RLE with no hormones and no surgery doesn't tell you anything about what your life will be like.

Literally the only thing that will change in my public life post transition is different changing rooms at the gym and different bathrooms, neither of which are safe for me to experience at 120 pounds with DD breasts (can't bind all the time). Experiencing that now won't prepare me for experiencing them after.

I don't have any intention of changing my behavior or interests after transition so I'm not going to before. Why is a whole year basically doing what I've been doing for 24 years only with a binder making it difficult to eat and breathe going to help at all?

Quote from: cheryl reeves on October 31, 2015, 12:13:47 PM
I'm not trying too cause any problems,but I still can't wrap my head around why so many transgender bulk at rle.

I resent a group of cisgender doctors deciding what test I need to pass before I'm allowed to be considered a member of my gender.

Quote from: suzifrommd on October 31, 2015, 04:24:05 PM
I resent a group of cisgender doctors deciding what test I need to pass before I'm allowed to be considered a member of my gender.

Yes, this. I also resent not being trusted as an adult to make life changing decisions.

There's no RLE for breast augmentation, despite high levels of regret there. What about having babies? If i was infertile or getting IVF would they make me carry a dolly around for a year?

ETA: @cheryl - just to clarify, I'm not mad at you, i'm annoyed by the NHS ;)

In my view, most of us are compelled to be "getting into" this because our lives are already barely liveable. It's amazing how so many cis people I've spoken to think admitting to being trans is something you can say on a whim, that going through transition is something you could "accidentally" do, just because you happened to feel like it at that time. Incredible.

I could understand the trepidation of parents dealing with a younger transgender child because the issue of whether they are making informed decisions is valid. But as very much an adult with a lifelong track record of knowing exactly what I want and not being stupid, I still get spoken to on this matter as if I am a child.

It takes much patience and teeth-gritting to get through it without putting someone's head through a wall sometimes.

I' think an arguement could easily be made that a year of RLE might be appropriate before having kids, too. ;)


OK, jokes aside, there's a LOT of misunderstanding here. That's in no small part because the guidelines are deliberately a little vague, so that clinicians have wiggle room, and also because how they get interpreted varies wildly from place to place.

The WPATH guidelines do NOT call for RLE before hormones. Anyone trying to require RLE before hormones is acting OUTSIDE of the established guidelines for transgender care.

The criteria for hormone therapy are as follows:
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC outlined in section VI);
4. If significant medical or mental health concerns are present, they must be reasonably well controlled.

That's all. No RLE.

Again, clinicians trying to require RLE for hormones are acting OUTSIDE of the existing standards of care, and irresponsibly. (Yes, I am aware that the NHS in the UK is still catching up to the modern SOC, but they are working on it.)

Basically, for most folks, the ideal full-transition (from one binary gender to another) would look something like: 6-12 month of hormones, followed by 12 months of RLE as the new gender, followed by GRS/GCS if desired.

There is wiggle room around RLE, don't forget. The requirement for RLE is to experience "12 continuous months of living in a gender role that is congruent with their gender identity."

That doesn't mean that if you were born with male genetalia and want female genetalia that you must go present as a woman for 12 months. It means that you need to present as whatever YOUR target gender identity is for that period of time. The reason why this was tweaked was to allow for a much broader, non-binary specrtum of options. WPATH has recognized that not everyone wants to be a binary gender (this is cool), and is making efforts to expand the WPATH guidelines to allow for whatever presentation fits YOU.

If you've been living as a neutral, non-binary (pick word of your choice here, please!) gender presentation for a couple of years now and hve come to feel that GRS is vital to that presentation, you do NOT need to go get an extra year of RLE as a woman/man to get it, under current guidelines. You just need those 12 months living as your target presentation.

I'm in favor. This is a huge deal. It's a massive, largely irreversible change. There are mental disorders which can also carry gender dysphoria - not common, but neither is being transgender.

In my opinion, it's not a hoop to jump through. It's reaching part of the goal. The goal, after all, is to live life as normally as possible as whatever our target presentation might be... The sooner we get going on that, the better. "RLE" isn't a year. It's the rest of our lives.

Should have added, too - one important reason to jump to HRT rapidly is the frequency of cases where it provides rapid relief to patients. A lot of the time, the hormonal change can provide enough relief that it's much easier to ride out the 12-24 months until surgery. There's some debate about how much of this impact is the actual hormone changes, and how much of it is the psychological improvement from taking real, concrete steps toward fixing our genders. But the source matters less than the effect, which is pretty well documented. Hormones help a lot of us.