Susan's Place Transgender Resources

Do any girls know if Dr Hayes ALWAYS requires a psych letter to commence HRT? If so I had better organise one.

I'd love to know also...

Girls?
Anyone?
Please?.......

Yawn. Sorry, it's only 8.30 Sunday morning, hon. Still waking up... ;)

To be honest, I don't know. You will require a referral to access the Medicare rebate for treatments, but that can come from a GP.

He's a very above the board kind of guy, extremely professional and supportive of trans people but in order to do things properly (for what's medically expected in NSW) I believe you will need a letter. Whether that can come from a counsellor with a GP referral I couldn't say.

Thanks Grace. I am due to see Dr Hayes in mid Feb so I will contact both my counseller and GP immediately. I must also say that I have been swapping messages with another girl on this site and she has been tremendously informative about this. Anyway I had better let you get back to your coffee and brekkie!
Ciao bella,
xoxo,
Roxanne.

As an aside I have to let this out; the closer I get to realising my decision to commence HRT the easier it's becoming to get abjectly sad about having a man's body. I need to be a woman now more than ever and it's getting more pressing! Unbelievale stuff. I hope that other girl who I have mentioned above can forgive my endless worries from last night.

If you have already booked to see him you should definitely check with his office ASAP for what is required and if a psych letter/referral is needed.

Big thanks again Grace, I will do that tomorrow but I have to admit this was messaged to me last night. So big thanks to all my helpful sisters on this site.

Quote from: roxie rudi on January 02, 2016, 03:53:04 PMAs an aside I have to let this out; the closer I get to realising my decision to commence HRT the easier it's becoming to get abjectly sad about having a man's body. I need to be a woman now more than ever and it's getting more pressing! Unbelievale stuff. I hope that other girl who I have mentioned above can forgive my endless worries from last night.

I'm feeling pretty similar, now I've made the decision to proceed - let's get going already!! Time is ticking on
It's not just you... xox

For your initial appointment with dear Dr. Jon, yes, you need a Psych referral. He likes to do things by "the book"

He is a very experienced clinician and knows his stuff backwards.

A good Endocronoligist needs at least 8 years training to understand the complexities of the endocrine system. He is well beyond that.

Speak to you as soon as I fix the fence.

Huggs
Catherine

But Dr Jon Hayes' office has already okayed my initial appointment. Did you mean his initial HRT prescriptions (or whatever they're called)?
On this subject does it have to be a psychiatrist's letter or can I make do with either a counseller's or a psychologist's letter? Remembering that I already obviously have a referral from a gp (who coincidentally has already had regular dealings with Dr Hayes while being experienced with transitioning too) to see him for starting HRT which might add to the spych requirements as far as Medicare is concerned. I'm only asking this because I am being rather impatient and I haven't forgotten the advice about contacting Dr Hayes' office for this ASAP. Sorry can't help myself. I'm with you on this Sam.

Hurry Hurry Hurry before I go Loco,
Can't control my fingers
and I can't control my toes,
Oh No Oh Oh Oh! 
(sorry just being a Ramones fan).

When I saw him for the first time I had my gp referral and somewhat old psych letter that had recommendation for hrt.

Thanks Luna, do you remember what type of psych practitioner it was from? Psychiatrist? Psychologist? Counseller? Me being damned impatient again because I can ring his office tomorrow to find out.

I have realised that you guys might be thinking that I'm being overly fastidious in my requests for the definitions of the psych practitioners involved in this. Sorry, I'll back off and call Dr Hayes' office as has been suggested to me. It's Sunday, a day to relax after all.
Ciao,
xoxo,
Roxanne.

Yes, especially since it just started raining.  :-\
Think I might watch a video or something.
Anyway, his office will know for sure - hope they are actually open tomorrow and not taking a few days off due to the silly season. Good luck!

...any word...? :)

Hi Grace.
No, not yet because his office is closed until Wednesday because of the Xmas hols according to a recorded message.
I tried for an appointment with a psychiatrist, Dr Carlson Loke today while I was using the the phone today but I couldn't make ANY appointment. ANYTIME. His appointments were all filled till who knows when. Sheesh!
I have however left a recorded message on Dr Michael Scott's answering service but I will keep trying until either I'm called back or someone answers.
I'm also awaiting a reply from Dr Suporn's Clinic regarding a birth defect of mine called "dextra (or dexter) Cardia." It's reasonably common and just means that I was born with my heart pointing towards the right side of my chest instead of normally pointing towards the left side of my chest. I also had a "hole in the heart" when I was born and this was surgically rectified when I was seven. These are both common congenital mix ups and neither has stopped me living a fit and healthy life. Indeed I still lead a very fit and healthy life, I don't smoke, I rarely drink and I don't take drugs. In fact I went to the gym today but I hope Dr Suporn and the anaestheologist are okay with performing FFS. I have promised to obtain any info from a cardiologist that he may require too.
And on Wednesday I'm going to get some dental work done as part of repairing my gap toothed grin.
But by all that's holy I'm getting sick of chasing medical matters and if I strike any psychological health providers that are merely after profit I'll....truly go nuts!
At least I'm on a break till the 11th.
Anyway Grace enough medical drivel, sorry for my long winded explanation and thank you for caring.

Ciao bella,
xoxo,
Roxanne

Good luck on Wednesday! Yeah, it's always a hassle getting onto any waiting list, not sure what they expect us to do with our mental health in the meantime...

I forgot to mention that I'm chasing psychiatrists because I'm trying to get my SRS requirements underway ASAP and not to deal with any further depression/anxiety/madness/craziness/fear/hatred caused by a lifelong "freakout". It's like I have mentioned; now the gates are open this little horse is bolting for the finish! I've made a decision and it's been way too long in coming!

I dunno if it is still a requirement in NSW/Australia but I presume so - as i understand it you need to have 12 months "Real Life Experience" (RLE) living as your identified gender before they'll write a letter of recommendation for SRS. RLE is generally meant to mean from when you start living full time as female though, not from when you start HRT or seeing a psyche.

Thanks again Grace but I have been told by my counseller that I might be able to expect some dispensation in regards to RLE. I live in one of Sydney's less than salubrious, working class, "tough" and somewhat declasse areas (albeit in a quiet suburb), I work in an industry that is as yet undeniably VERY masculine (and terrible towards female equality in the workplace, let alone transgender equality in the workplace), in the past I have been very naughty towards the laws of our nation and I have been hospitalised for some crazy stunts involving both motorcycles and motorcyclists. I am hoping that I might be able to avoid RLE because of these things, to a degree, because it might get me "bashed" and certainly sacked. But if not then I'm hoping that I can be cunning enough to avoid it when I have to.
However when I get HRT and FFS (which will be happening beforehand) I cannot see any problem whatsoever with RLE. To be honest I am crying for just this to become my reality!   

Quote from: roxie rudi on January 04, 2016, 05:40:51 AM
Thanks again Grace but I have been told by my counseller that I might be able to expect some dispensation in regards to RLE. I live in one of Sydney's less than salubrious, working class, "tough" and somewhat declasse areas (albeit in a quiet suburb), I work in an industry that is as yet undeniably VERY masculine (and terrible towards female equality in the workplace, let alone transgender equality in the workplace), in the past I have been very naughty towards the laws of our nation and I have been hospitalised for some crazy stunts involving both motorcycles and motorcyclists. I am hoping that I might be able to avoid RLE, to a degree, because it might get me "bashed" and certainly sacked. But if not then I'm hoping that I can be cunning enough to avoid it when I have to.
However when I get HRT and FFS (which will be happening beforehand) I cannot see any problem whatsoever with RLE. To be honest I am crying for just this to become my reality!   

I don't really understand this point. RLE is only required for SRS, and how does SRS affect you chances of having these problems?

Sorry Ms, HUGE misunderstanding. SRS does NOT cause these problems, I meant RLE might cause these problems. My novice's understanding  is leading me to believe that living full time as a woman while being obviously recognisable as a man will get me in big trouble in public. By my experience this is often the case among even homosexuals but if I can develop and adapt my transition while it is occurring I am hoping to be safer.
Those who are different are those who most often suffer from violence meted out by those who cannot understand.
From what I have seen and from what I know I will get "p****** bashed" quite easily if I cannot make myself at least look different to a male living as a female. Remembering I am unaware of RLE and its strictures but while I am not demanding a need for passability I will need to be able to hide my transition until I feel ready to come out.
I also hate being told how I must live. But that's cool cos' I'm sneaky!

I was thinking of RLE occurring before SRS that's all. Thus the problems.

You don't need to do RLE anytime soon unless you want SRS and even that's flexible. You could have SRS well after you've successfully socially transitioned if you wanted to - no one is going to know when you've done it.

You can have HRT and FFS without RLE.

I've been on HRT many years and I've never done RLE, never presented female to Dr Hayes, my psych, or therapists. Almost no one knows.

At some point there's going to be the awkward social transition, but I've been putting it off for various reasons.

Also, not that it matters, but it was me that made that previous post, not Grace.

Hi Ms. Yes I noticed it was you and you can easily see that I have modified that. My mistake and I apologise if I have been rude because of this.
I realise your points about RLE and if you read the penultimate paragraph in that post you should notice this.
In fact the entire post is about my own personal worries for RLE. But As I have said I am hoping for certain dispensations for RLE. Maybe I'll get them, maybe I won't. Regardless I'm keen to be doing things now that I have made up my mind. Even if they lead me in the wrong direction for the moment.
HRT, FFS and SRS here I come!

Thanks for being thoughtful with that FFS video too.
Ciao bella,
xoxo,
Roxanne.

My plan if I ever social social transition my plan is to try to make the transition time as short as possible. I've been on HRT a long time so I'll have as much change there as possible.

I've not done any facial hair removal though and that would very slow. Probably I'd do electrolysis while still presenting male, then get FFS and BA and swap immediately after that. Maybe 1 to 2 years delay from where I'm at now. I've no idea though if it would work like that in practice; only one way to find out.

Hi Ms. I have to admit that I might take a very similar route myself. HRT for about 10 months to a year while trying to present as male. Then immediately undergo FFS into full time followed by SRS. But the shrinkage in muscle mass from HRT will cause a lack of physical strength which will get noticed because of my job. Oh well, I'll just sail on into my dream no matter what.  Onward, ever onward!
However I am in too much of a hurry to take my time and be considered. The gates are open now and I'm running. At least I have surgery money put away in term deposits which I don't have to otherwise touch.
But I have to say that you're a mystery, in a cool way. You will be a butterfly, suddenly beautiful!

I'm off to see an old friend in the morning so good night, sleep well!

Ciao bella,
xoxo,
Roxanne.

I feel like more like a mystery in a crazy way.

If your job is very physical you may have trouble hiding breast development. If you do the usual vests and baggy shirts it can get very hot. You might not be able to keep it up on the Sydney heat. Depends on how much and how fast they grow as well.

A beard hides your facial changes, so I've kept it. I look odd otherwise.

Does anyone know if you have to fully clear facial hair before FFS?

Thanks again Ms, I'm sure you'll be a mystery in a beautiful way. Just being your true self is a beautiful thing.
Yep you're certainly right about clothes and the heat but I should be undergoing HRT's most notable changes once summer is over and I don't care about growing a beard because it will be in the best of causes to me. To have breasts is a wonderful thing for me so I will do what is necessary. And remember I said that I am sneaky so if hiding my transition needs baggy clothes then so be it!
If I have to change industry then I will. I at least have an Occupational First Aid ticket alongside Cert 4s and Diplomas from TAFE that might allow for this.
Oh no....I should have thought about facial hair, FFS and timing! I wish I had been as considered as some of my cleverer sisters. Like you. But oh well can't win 'em all. Or any of 'em. But if you check out other posts of mine in this thread you will note that my plate is somewhat full at present because of my breathless run for some open gates. In short I have only recently decided to undergo a long overdue transition and I am trying very hard to avoid anything that might delay this but I am obviously forgetting things in my rush.


Ciao bella,
xoxo,
Roxanne. 

Hi Roxie, your thoughts on RLE are pretty much most peoples. Isn't Sydney the most LGBT friendly place in Australia? I grew up in a rough place so I know how it is, unthinkable for anyone to be gay let alone trans. 

Hi Serenation.
Yes parts of Sydney certainly are LGBT friendly whereas parts of Sydney are far from LGBT friendly. Admittedly Australia in general is pretty laid back vis a vis LGBT matters but it still is dangerous in many places because ignorance abides among those without the wherewithal to live better lives or receive better educations. But that's not their fault.
To steel some old Midnight Oil lyrics I will say this;
"The rich get richer,
the poor get the picture,
and I just don't know!
You wouldn't read about it!"

Quote from: roxie rudi on January 02, 2016, 09:19:54 PM
But Dr Jon Hayes' office has already okayed my initial appointment. Did you mean his initial HRT prescriptions (or whatever they're called)?
On this subject does it have to be a psychiatrist's letter or can I make do with either a counseller's or a psychologist's letter? Remembering that I already obviously have a referral from a gp .........

Hi Roxie,

Essentially to go by the letter of the law, Dr. Hayes needs a letter from a licences Psychiatrist stating that after examination he has found no co morbidities or psychiatric conditions that would impede your transition and recommends you for hormone replacement therapy. The rest is up to Jon.

A psychologist is not trained in this type of work to make such a statement.  Have you got a Psych in mind? Do you know Dr.Patrick Toohey, Concord Hosp?? or Dr. Brash Warners Bay?

Huggs
Catherine

Quote from: Catherine Sarah on January 06, 2016, 11:44:58 AM
Essentially to go by the letter of the law, Dr. Hayes needs a letter from a licences Psychiatrist stating that after examination he has found no co morbidities or psychiatric conditions that would impede your transition and recommends you for hormone replacement therapy. The rest is up to Jon.

Actually that's not quite correct. He's free to do whatever he thinks best, which would appear to be asking to a psych letter.

Thanks very much for helping out a newcomer girls.
I will hope for the best in regards to my initial appointment with Dr Jon Hayes and I have been trying to arrange an appointment with a psychiatrist, Dr Michael Scott. I was given the names of Dr Carlson Loke and Dr Toohey by my Gender Centre counseller but Dr Loke has absolutely no appointments available, ANYTIME, and Dr Toohey and Dr Scott are still both on Chrissy hols. Additionally I called Dr Hayes' office yesterday and was told that a psychiatrist's letter was what was usually asked for. Furthermore I have left an email and a phone message with Dr scott.
Regardless I will just keep at these guys until they see the truths of the real me! I will not give up because to do so would only cause me to spiral into the very pits of hell and I just want to be happy and free as the woman I often cry myself to sleep as now that I know what is available for the purposes of transitioning.
No I hadn't heard of Dr Brash Catherine but thanks! Another opportunity to pursue. Away I will go to the phone!

Yay! Yay! Hooray! I have just made an appointment with a psychiatrist for the 25th of this month and it's on one of my fixed RDOs! It even preempts my appointment with Dr Hayes. But taking the good with the not so good my consultation is to be with Dr Patrick Toohey of whom I have read some negative things on this site...oh well, at least I'm not standing still! Yet.
I have also received a reply via email from my Gender Centre counseller that is very lovely and wonderfully encouraging!
I just hope some bad news doesn't now show up to hurt me.
Anyway girls I'm off to my GP to organise a referral for Dr Toohey, bye!

We all will bloom! I will bloom too! We all are beautiful!  I am beautiful too!

Ciao mi amores,
xoxo,
Roxanne.

I saw Toohey for my "second opinion" letter and I know some people find him a bit old school but honestly I found him to be a very supportive psyche. He sees a large number of trans people on a regular basis - I'd suggest being factual with him, he'll probably try to give you a bit of a lesson about the brain or something but he should be OK. If you have a letter from your counsellor detailing treatment to date it will probably make things go a lot more smoothly.

Hi Grace.
Thank you for your info, what you have said about Dr Toohey is encouraging me. I have also just emailed my counseller desperately asking for her help in providing an outline of her treatment for this purpose. She's always helpful and I thus have reason to hope for her timely aid in this matter.

Bye!
xoxo,
Roxanne.

Grace I feel like I will be tested. But I know what I feel about my true self. It's OVERWHELMING. Sometimes I feel like my breath has been taken and sometimes I find myself sobbing. Though I am never inured to it.
But your suggestion to be factual will help to ground me for this appointment. Thank you.

Hi Roxy rudl

Coming from a post-op girl, I can understand your frustration and hastiness. However, trying to rush transition and complete SRS before even living full time  or having laser hair removal is never a good idea in my opinion.

The purpose if RLE is not to lake your life more difficult. On the contrary, RLE just makes you realise the huge challenges that await you living as a full time woman. I am not a psychiatrist, nor do I think I have the right to say who should have hrt or srs. However, I am a firm believer in the fact that RLE has its huge merits. It makes the transition process smoother and more gradual. It helps you explore the challenges/ difficulties living as a transgendered woman. It will also help you find your own style,  clothing, mannerism, voice as well as help you develop strategies to deal with transphobia in all its forms, which in turn will help you effectivelt integrate into society as a woman. The occuoational aspect of RLE is.equally important as it will show you whether you can operate in society and make a living as a woman.  I know of people who have detransitioned, and a few months after going full time. They realised they couldn't assume living as a female for whatever reason. They were also glad they hadn't undertaken any non-reversible steps such as ffs or SRS. These were people who were initially as sure as God made apples that they wanted to fully transition into being a female. So RLE has its merits, in my opinion, and it's there for a reason so please don't rush things, hun.


I did it the other way around actually. I went full time for a few months while after having had 6 sessions of laser hair removal. Then, I had two gender specialist aporoval for hrt. The rest is a smooth and gradual progression into being the happy stealth post-op woman I am today.

Hugs,

Rita

Thanks for your concern Rita.
I am not trying to rush anything I am merely trying to organise things because I have a very busy life otherwise. I am completely new to any trans community and so I show my ignorance too often, I don't waste time in general, I am returning from my Christmas break to a newly acquired 6 day week job on Monday that entails normal days that start at 6.30am and finish at 5pm and I have been somewhat anti social throughout my life so I don't really care what society in general thinks about me despite my newbie's desire for a passability that comes under my fixed need to be seen as the woman I know myself to be.
But what you have stated makes perfect sense and I have absorbed it with respect and I hope that I have understood it. Especially because you obviously have greater experience in all transgender matters than I do.

Ciao bella,
xoxo,
Roxanne.

I am glad you took my feedback on board. I was.worried you might get the wrong of the stick. Whetever you decide, I wish you the best of luck hun!

Rita

Thanks again Rita and I wish you the best of luck in all your life's endeavors too babe, no matter what they are!
I am aiming for what you beautifully are already, a happy post-op stealth woman and I'm not rushing that, only determined to organise matters as effectively as both my time and ignorance allow! Bye!

xoxo,
Ciao bella,
Roxanne.

Quote from: Ms Grace on January 07, 2016, 01:17:32 AM
I saw Toohey for my "second opinion" letter and I know some people find him a bit old school but honestly I found him to be a very supportive psyche. He sees a large number of trans people on a regular basis - I'd suggest being factual with him, he'll probably try to give you a bit of a lesson about the brain or something but he should be OK. If you have a letter from your counsellor detailing treatment to date it will probably make things go a lot more smoothly.

I've seen Dr. Toohey also and found him lovely and very caring. I suspect some people try to moderate what they tell their therapist, to try and get the outcome they want, which is where the trouble starts. Therapy can only be effective if you're completely honest.

Good luck!

xox
Sami

Quote from: Catherine Sarah on January 06, 2016, 11:44:58 AM
Hi Roxie,

Essentially to go by the letter of the law, Dr. Hayes needs a letter from a licences Psychiatrist stating that after examination he has found no co morbidities or psychiatric conditions that would impede your transition and recommends you for hormone replacement therapy. The rest is up to Jon.

A psychologist is not trained in this type of work to make such a statement.  Have you got a Psych in mind? Do you know Dr.Patrick Toohey, Concord Hosp?? or Dr. Brash Warners Bay?

Huggs
Catherine

Actually I don't think that's correct. WPATH, the new DSM-5, proposed ICD-11 have moved away from requiring an psychiatrist referral for HRT/endocrinologist. I can't find any statement in WPATH that requires a psychiatrist - it only refers to adequate "psychotherapy".

To clarify, psychiatrists are medically trained, and then train in psychology. Psychologists are not medically trained, however are still trained in psychology. Clinical psychologists have attained a Masters in psychology.

I think we need to be careful with the facts here- because there is a bottle-neck in transgendered people getting access to HRT - which is that many endocrinologists will only take referrals from psychiatrists. While this is the case, there is a very real risk that tg people might kill themselves, whereas HRT is known to relieve gender dysphoria.

DSM-5 and ICD-11 are moving to an "informed consent" model.

If I'm wrong then correct me - otherwise let's please be clear on this. If properly skilled psychologists and psychiatrists can refer - this alleviates the bottlenecks

xox
Sami

The bottleneck might also be due to the number of endocrinologists willing and able to take on trans clients, which could be fairly limited even in Sydney.

Quote from: SamKelley on January 22, 2016, 04:54:13 AM
Actually I don't think that's correct. WPATH, the new DSM-5, proposed ICD-11 have moved away from requiring an psychiatrist referral for HRT/endocrinologist. I can't find any statement in WPATH that requires a psychiatrist - it only refers to adequate "psychotherapy".

Bear in mind that there's no legal requirement for doctors to follow WPATH or ICD-11. Whatever Dr Hayes is doing, its his choice.

Hey guys, thanks again for the pool of knowledge that always seems both freely and thoughtfully given. I honestly feel grateful for this.
Where the subjects of this thread are concerned I personally will not be too concerned with the exact legal requirements or phraseologies of these matters. Primarily this is because I am to see Dr Patrick Toohey on Monday and I will be nothing but honest with him because I know that GD has been driving me bonkers for too much of my life. I'm sure I have in no way been alone in this matter. We know when we have felt the woman trapped inside by the male outside. Am I right sisters?
And secondly a person versed in things utterly removed from medical practices, such as myself, would be a fool not to invest some trust in practitioners as highly spoken for as Doctors Toohey and Hayes.

While Monday's appointment is certainly not my first action towards transitioning it is however my first large and concrete step, so at this moment all I can really say is....... PHEW..... I hope it doesn't go awry.

I apologise but I shall leave you girls discussing the exactitudes of this matter while I go out and surreptitiously window shop at some pretty clothes in order to find strength and encouragement for my upcoming ordeals. I am a legal and medical dummy who relatively only wants to look great but nonetheless I know that you are helping me via your experience, care and knowledge and I am honestly grateful for all this (while also being nervous of all that might come).

Ciao,
xoxo,
Roxanne.

Hi Roxie,

Was thinking about you earlier today and wanted to wish you all the best for your appointments next week.

It's a bit late, but my experience was; I didn't find the whole thing quite as scary as I thought it would be.

I can understand why some people find Dr Toohey a bit of a struggle, but he is kind and tolerant.  For me, I was worried that the whole process seemed open-ended, although I was feeling quite vulnerable to start with.  I resolved that it was in my interests to be totally honest and transparent with him, even if I found it shameful or humiliating.  It seemed as if Dr Toohey had exhausted all the questions he had, and still didn't give me any diagnosis or determination, and so I kept turning up to appointments after I felt we had run out of things to talk about.  Eventually I started to feel a little exploited, so I became a bit more assertive, and asked directly whether he had sufficient information and would provide me an endorsement or not.  He told me he had no reservations, and the letter of endorsement arrived very promptly.

I've also spoken to Dr Scott on the phone.  He was very open and direct and made me feel very comfortable.  Even on the phone, he made it clear to me what information he needed and how much time we would need to spend together for him to make a determination.  If I need further referrals or letters, he would probably be my first choice, although I would be ok going back to Dr Toohey also.

I found Dr Hayes amazing.  He never actually asked for the pysch endorsement letter, and when I volunteered it towards the end of the appointment, he never even read it, just popped it in the file.  I found him to be the most compassionate, understanding, humane medical provider I have dealt with so far.  He was much more concerned about my experiences in my own words than a psych's interpretation of them.  Ironically, Dr Hayes was the most affordable appointment in my medical transition, and I left feeling human, dignified, prepared, and informed when leaving his clinic.

I have my first follow-up with Dr Hayes next week.

All the best for your appointments next week.  Thinking of you.

P.S.  Have you seen The Danish Girl yet?  What did you think?

I concerned with the technicalities of it all because its caused me a great deal of problems over the years. Or perhaps I should say I've caused myself a great deal of problems though misunderstanding how it all works. A lot of common knowledge is just plain wrong, not applicable to Sydney, or not to my situation.

Quote from: Claire_Sydney on January 22, 2016, 09:23:56 PM
I have my first follow-up with Dr Hayes next week.

Are you getting implants? They are the best, but I don't know if he does those to start off with.

Quote from: SamKelley on January 22, 2016, 04:54:13 AM

Quote from: Catherine Sarah on January 06, 2016, 11:44:58 AM
Hi Roxie,

Essentially to go by the letter of the law, Dr. Hayes needs a letter from a licences Psychiatrist stating that after examination he has found no co morbidities or psychiatric conditions that would impede your transition and recommends you for hormone replacement therapy. The rest is up to Jon.

A psychologist is not trained in this type of work to make such a statement.  Have you got a Psych in mind? Do you know Dr.Patrick Toohey, Concord Hosp?? or Dr. Brash Warners Bay?

Huggs
Catherine

Actually I don't think that's correct. WPATH, the new DSM-5, proposed ICD-11 have moved away from requiring an psychiatrist referral for HRT/endocrinologist. I can't find any statement in WPATH that requires a psychiatrist - it only refers to adequate "psychotherapy".

To clarify, psychiatrists are medically trained, and then train in psychology. Psychologists are not medically trained, however are still trained in psychology. Clinical psychologists have attained a Masters in psychology.

I think we need to be careful with the facts here- because there is a bottle-neck in transgendered people getting access to HRT - which is that many endocrinologists will only take referrals from psychiatrists. While this is the case, there is a very real risk that tg people might kill themselves, whereas HRT is known to relieve gender dysphoria.

DSM-5 and ICD-11 are moving to an "informed consent" model.

If I'm wrong then correct me - otherwise let's please be clear on this. If properly skilled psychologists and psychiatrists can refer - this alleviates the bottlenecks

xox
Sami

A couple of points, while clinical psychologists letters are accepted it is up to the endocrinologist to make their own determination as well. Some endos and surgeons are reluctant to accept an opinion from a psychologist that they do not know the competency of. Since the provider takes the legal risk then they make their own judgement based on their knowledge of the situation.

Their is a real shortage of endocrinologists and a reluctance by GPs to give HRT, that needs to change. My GP now looks after my HRT but she has access to an endocrinologist for advice if she is unsure of anything.

Informed consent is not hormones on demand. That is often misunderstood. The informed consent model in Adelaide take a total of one hour and 45 mins spread over three sessions, but the bottleneck is getting the first appointment due to demand.

Quote from: Cindy on January 23, 2016, 12:39:10 AM
Informed consent is not hormones on demand. That is often misunderstood. The informed consent model in Adelaide take a total of one hour and 45 mins spread over three sessions, but the bottleneck is getting the first appointment due to demand.

I've only really heard about informed consent in the USA, and I have the impression there is that it is on demand. I've very mixed feelings about that, even though I would want it on demand for myself.

Adelaide sounds like its using the proper medical definition of informed consent.

I'm curious, what model is used in Sydney?

Quote from: AnonyMs on January 22, 2016, 10:43:53 PM

Are you getting implants? They are the best, but I don't know if he does those to start off with.

We did discuss it, and it sounds like an effective delivery method (and perhaps a bit easier on the liver?) 

I'm only taking estrogen tablets at the moment, so I think the plan is to introduce an AA next week.  Perhaps after I've adjusted to that a bit. :)

BTW, I few things I forgot to ask - Do the implants completely break down, or does some residue have to be removed afterwards?  Do you have ongoing pain/tenderness at the implant site?  Do you go back to the endo for regular replacements, or does your GP monitor your bloods and inject them for you in the long term? 

Thanks AnonyMs !

Quote from: Claire_Sydney on January 23, 2016, 01:04:07 AM

Quote from: AnonyMs on January 22, 2016, 10:43:53 PM

Are you getting implants? They are the best, but I don't know if he does those to start off with.

We did discuss it, and it sounds like an effective delivery method (and perhaps a bit easier on the liver?) 

I'm only taking estrogen tablets at the moment, so I think the plan is to introduce an AA next week.  Perhaps after I've adjusted to that a bit. :)

BTW, I few things I forgot to ask - Do the implants completely break down, or does some residue have to be removed afterwards?  Do you have ongoing pain/tenderness at the implant site?  Do you go back to the endo for regular replacements, or does your GP monitor your bloods and inject them for you in the long term? 

Thanks AnonyMs !

They break down completely over 6 months or so, after the wound has healed there is no tenderness ( you often need a stitch to close the incision), yes the end replaces them every 6 months or so after they get use to your hormone levels which vary a bit between individuals.

Implants do completely breakdown and there is nothing to be removed (that would be bad!).

You get regular blood tests to show you blood levels and when it goes below 800 pmol/L you get a new one.

After a few of them it will be clearer how long they will last you. Everyone is different. You need to go back to Dr Hayes for the next one. I've not heard of a GP doing it, but after seeing Dr Hayes there's no way I'm letting a GP anywhere near me.

Its a minor surgical procedure. There's been descriptions in the past on the forums (I've made some). Its got a bit easier recently as he's changed the size of the implants. Do some searching.

I find them far superior to what I've had before. I think mine last about 9 months, perhaps more. I can basically forget I'm taking medication, and I like that. You don't need to stop HRT for SRS either, which is a nice advantage if you want that.

Thanks again Claire and Ms. I feel wonderfully emboldened knowing that you have been thinking of me Claire, that is nothing short of amazing! My Gender Centre counseller telling me of this website has been an unsullied source of beauteous  awakening for me because of gorgeous women like you!
Unfortunately I am "coming in from the cold" so to speak and I have thus had no prior knowledge of what, or who, is around to help us. All I've ever had has been a burning necessity and my beaten up lap-top to find ways to sources of aid until I came upon you guys. I didn't really even know that transition was likely to be possible until a little more than a year ago when I struck HRT timelines on Youtube. I WAS DUMBSTRUCK. Prior to that all I knew of were people like Danni La Roux(?), Carlotta and Ru Paul. And myself in my dreams. Which all had to be kept very secret.
To make matters considerably worse I too often ignore mainstream media because I find that it, for the most part, dribbles on about the status quo. But because I ignore it I missed out on the societal advent of girls like Jazz and women like Caitlyn . Additionally my own lifeway has buried my freedom under (what is to me) a stagnant pile of testo driven dishonesty because I have been raised to the belief that what I have been doing is "what blokes do".
Please realise I AM NOT SEEKING SYMPATHY, I AM ONLY LETTING MY BEAUTIFUL SISTERS KNOW WHERE I AM COMING FROM and no doubt MANY OF MY SISTERS HAVE SUFFERED MUCH, MUCH WORSE than I.

At least I will be armed with the knowledge that my appointment with Dr Toohey will shortly be followed by my initial consultation with Dr Hayes and this might provide some honest and medically sanctioned leverage for my own case. Just a hope but so far Dr Toohey has been nice to me (I've had to speak directly to him because he has been answering his own phones and stuff lately) and I'm supported by a really, really great letter from my Gender Centre counseller who has been a HUGE HELP to me.

I am currently working in a job that requires long hours, 6.30am-5pm, six days a week which I am hoPing to hold until August-November by which time I will have saved the dollars necessary for FFS, SRS and maybe even BA but I don't need BA like I need FFS or SRS. But I've been thinking more and more about boobies lately. This doesn't mean I am hoping for these surgeries in this time as I know I must at least bestride the path of my necessary biological road.

Claire I have been unable to see The Danish Girl yet because of the reasons given directly above about my working hours but I will soon! I hear that it is very sad despite the fact that you are helping to dispel the sadness caused by me feeling alone.

Ms. I will be asking Dr Hayes for implants thanks to advice you have already given me. Gel or patches won't work because my job can often lead to strenuous and sweaty activities and pills/tablets might not be given for whatever reasons.

Anyway thanks again
ciao mia sorelle,
xoxo,
Roxanne.

It's highly unlikely he'll start you directly on implants - you'll probably need (at the very least) six weeks on a starting course of pills to get your biology accustomed to the estrogen. In large part it will be down to your current health, fitness (things like weight, age, blood pressure, blood sugar, cholesterol, liver function, kidney function, etc), family health history and so on.

Quote from: roxie rudi on January 23, 2016, 01:21:55 AM
Ms. I will be asking Dr Hayes for implants thanks to advice you have already given me. Gel or patches won't work because my job can often lead to strenuous and sweaty activities and pills/tablets might not be given for whatever reasons.

Generally not recommended over 40 years of age.

It probably depends on health factors - I was 47 but he started me on on pills. After six weeks he added a gel. From memory I went onto implants after 12 weeks and dropped the pills and gel. Someone I know who is over 50 was started on gel or patches (can't remember which), went onto an implant after ten weeks I think.

My understanding of the gel is that it is absorbed very quickly. I was concerned about sweating too but he said that it wouldn't be an issue.

Thanks Grace. I should be okay, my bloods are "perfect" according to my gp, Dr Santos who often works with Dr Hayes and furthermore I have always been, and still am, keenly aware of my fitness and health because of congenital heart defects that I had to have surgically rectified when I was seven. I don't smoke, I go to gym three times a week despite working loooong hours, I rarely drink and I haven't indulged in  drugs for years.
I have no worries in this matter regarding my health or fitness. I'm only waiting to see my cardiologist so that he can get my okays ready for eventual surgeries with Dr Suporn.   

Hi again Ms. There are two factors which might go against oral HRT in my case; my age (which is 46) and I have undergone  cardiac procedures, albeit when I was younger and a more recent ablation of scar tissue from that procedure to forgo any subsequent problems. It's a relatively simple procedure to ensure that old surgical methods don't cause subsequent problems. Newfound techniques for oldschool methods. That sort of medical thingy!

Fab!

Thanks Cindy, Ms.


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Quote from: Ms Grace on January 22, 2016, 05:05:52 AM
The bottleneck might also be due to the number of endocrinologists willing and able to take on trans clients, which could be fairly limited even in Sydney.

Yes agree 100% - and endocrinologists don't seem willing to accept referrals from psychologists either, generally speaking.

Quote from: AnonyMs on January 22, 2016, 05:12:03 AM
Bear in mind that there's no legal requirement for doctors to follow WPATH or ICD-11. Whatever Dr Hayes is doing, its his choice.

No there isn't. My point was if we also perpetuate that endocrinologists can only take referrals from psychiatrists, when that isn't in the literature, we become part of the cause of this bottleneck.

Yes Sami I honestly and completely agree. We shouldn't perpetuate myths that might prolongue our suffering.
I am one of the first to stand up and not be obeisant to someone elses' self aggrandising lies. I do not take sh*it, believe me. BUT in my case here I called Dr Hayes' office as was suggested in an earlier post on this thread and low and behold I was told I would MOST PROBABLY need a psychiatrists' letter to begin HRT.
I know, I know, I'm the so-and-so who posited the original question about what referrals would be necessary to begin HRT but even Dr Hayes' fellows are directly involved in perpetuating the myth of psychiatry being a necessity for this.

Nevertheless Sami I thank you and Ms. and all the other girls here who have shown this myth to be no more than some weird degree of atavism(?) on all our behalves and I will hopefully be able to use this in conjunction with Claire's advice to avoid spending too many bucks on psychiatrist's appointments.
I know what and who I am.
I know what I need to do and any person's obfuscation in this matter, professional medico or otherwise, will not be helpful.
And it will be a problem which I will only duck and weave anyway, no matter the medico's plaudits etc.
So I will return to avoiding and ignoring legalities when I am capable of doing so without hurting others because I am me and I am not mentioned in the Australian Constitution Act which is the basis of our commonwealth's law (the Lion and the bloody Unicorn and all that palaver). But I will be a dead set sneak and adhere to legal necessity to commence HRT because I know the woman I am wants to get out and about.
Thank you Sami we really shouldn't perpetuate myths that uphold anything that might prolongue our suffering.

Ciao Bella,
xoxo,
Roxanne.

Quote from: roxie rudi on January 23, 2016, 11:27:40 AM
Yes Sami I honestly and completely agree. We shouldn't perpetuate myths that might prolongue our suffering.
I am one of the first to stand up and not be obeisant to someone elses' self aggrandising lies. I do not take sh*it, believe me. BUT in my case here I called Dr Hayes' office as was suggested in an earlier post on this thread and low and behold I was told I would MOST PROBABLY need a psychiatrists' letter to begin HRT.
I know, I know, I'm the so-and-so who posited the original question about what referrals would be necessary to begin HRT but even Dr Hayes' fellows are directly involved in perpetuating the myth of psychiatry being a necessity for this.

Its not really a myth in this case. If Dr Hayes says its necessary then it is, because he's not going to give it to you otherwise.

The myth is that there's some kind of law that doctors have to follow, when its actually their choice.

I don't know how difficult it is to get a psych to write such a letter in Sydney, but I'd imagine its pretty easy, assuming you're trans and don't have any other problems. When I first started I thought it would be difficult and you'd need to get diagnosed with a mental disorder (which may have been true at the time, I don't know). I wanted low dose HRT and no transition at the time, and I wasted a lot of time and effort working around non-existent problems.

I know how now, and I've no moral issues working around the system, but there's simply no point. Not here.

I suspect what we have in Sydney, at least seeing the right psych's, is proper medical informed consent. The psych evaluates you to make sure you're informed and more to the point capable of consenting. They are not evaluating you to make sure your the right kind of trans, and you don't have to present female to them. I very much doubt you'd have a problem if you're non-binary. Assuming that's the case then I think its pretty reasonable of Dr Hayes to ask for it, and there's no harm in doing so. Its not his job (or expertise) to asses people's mental state.

The MOST PROBABLY likely means that there are cases where he won't ask for a psych letter. Perhaps if you're already on HRT or post-op.

When I see Hayes next I'll ask him.

So I saw Dr Hayes today and asked him: "A friend was wondering how they might go about seeing you..."

He said that a doctor's/GP's referral was necessary for the Medicare rebate claim (you get a bit back, not a lot). He added that "general practice" was to also include a referral from a psychologist or a psychiatrist.

I originally went to Hayes via a referral from a psychiatrist, which covered me as far as the rebate was concerned too so I didn't need anything from my GP. (I don't know if a referral from a psychologist or a counsellor would cover you for Medicare.) However a psychiatrist referral only lasts a year and needs to be renewed, a GP can write one that has no end date. Once my psychiatrist referral to Hayes was expired I just got one from my doc and that was well over a year ago now.

As for my appointment today, my E had just started to dip below the magic 800 mark so I'm now running on a new implant. Everything else is going really well!

Perhaps this thread should be more properly called 'We are all going to see Dr Hayes sometimes this week'.

Good to hear you're all refuelled (?) now Grace.

Happy Australia Day everyone!


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He's a popular guy!

Quote from: Ms Grace on January 25, 2016, 12:39:10 AM
I originally went to Hayes via a referral from a psychiatrist, which covered me as far as the rebate was concerned too so I didn't need anything from my GP. (I don't know if a referral from a psychologist or a counsellor would cover you for Medicare.) However a psychiatrist referral only lasts a year and needs to be renewed, a GP can write one that has no end date. Once my psychiatrist referral to Hayes was expired I just got one from my doc and that was well over a year ago now.

I got Indefinite Referrals for both Dr Hayes and my psych. The first GP I asked would only write it for a year, so I went elsewhere.

Education guide - Indefinite referrals – what you need to know
http://www.humanservices.gov.au/health-professionals/services/education/education-guide-indefinite-referrals-what-you-need-to-know

It looks like the psych referral would be valid only 3 months, so far as medicare rebate goes.

Referrals under Medicare
http://www.humanservices.gov.au/health-professionals/subjects/referrals-under-medicare

These referrals are only so you can get your medicare rebate, you can go without them if you didn't care about the money. I booked Dr Hayes before having a referral, and got one before I saw him. These first referrals were only for a year.

Happy Australia Day girls! I love Australia as much as I love the world as a whole. Odd really. No room for racism inside me because I'm f****** lost when it comes to similar matters, especially sexism.

To be precise a myth is something that becomes popularly accepted as an explanation for matters that involve the supernatural. For example the Gods of Olympus are mythical. Whereas a legend is something that purports to be historical explanation. For example King Arthur is legendary. However I also know that there is some overlap between these. For example King Arthur has a magical (supernatural) sword called Excalibur.
IS EVERYONE BORED?

Okay. So yes we can use the term "myth" to loosely describe Dr Hayes' demands for a psychiatrist. I shall duck while everyone gets angry and hurls abuse/brickbats/knives/rocks and whatnot at me for being cheeky! He he he he!

Luckily I saw an agreeable psychiatrist yesterday but unluckily I have to return to see him in late February. Additionally I am to see Dr Hayes in just under 3 weeks time. This is driving nuts because I have discovered an escape route that I can't yet take with any abandon. I shall ask Dr Toohey for "the letter" at the end of Feb and return to Dr Hayes with it ASAP.

Gonna' be feminine, gonna' be beautiful. And not just in my dreams!

Ciao mie bella sorelle,
xoxo,
Roxanne.

Get a referral from your GP to see Hayes, tell his office that you are currently seeing Dr Toohey and I expect they will be able to work with that.

Quote from: roxie rudi on January 25, 2016, 06:45:31 PM
So yes we can use the term "myth" to loosely describe Dr Hayes' demands for a psychiatrist.

As I mention above, it's not a myth but it's also not a demand. Currently he considers it the practice to require one from a psychiatrist or a psychologist.

Thing is, Hayes will most likely require you to have a blood test before he starts prescribing anything. Usually it is your second appointment with Hayes where you'll get a script. I was able to get back in for my second appointment fairly quickly (about 7-10 days) but that was a few years ago, don't know what his schedule is like these days. At any rate, you'll be able to ask Toohey to write directly to Hayes, I believe they both know each other professionally. I'm sure everything will align for you one way or another and very soon.

Believe me I very much understand the frustration of wanting to start HRT, I remember mine quite clearly. Thing is, you are moving at a good pace and it's not as far away as seems.

Quote from: AnonyMs on January 25, 2016, 04:02:43 AM
I got Indefinite Referrals for both Dr Hayes and my psych. The first GP I asked would only write it for a year, so I went elsewhere.

Thanks AnonyMs I didn't know this, that's really important information! xx

Thanks very much Grace.
I have already supplied Dr Hayes with a GP's referral. In fact the GP is a Dr Santos whose name was supplied to me by the Gender Centre for just this purpose. To make things even better Dr Santos has already told me that he has worked with Dr Hayes to transition girls. And even more betterer Dr Santos arranged for my transitioning blood tests which I then forwarded to Dr Hayes.
I am going bonkers and my clock has been ticking for tooooo long and without the girls on this site and my GC counseller I don't know where I'd be right now. All I know for certain is that I'd still be lost.

Ciao bella,
xoxo,
Roxanne.