Susan's Place Transgender Resources

The reason I ask is that I have my HRT appointment coming up and I was curious what sort of success people have had with this route. My provider seems to be supportive, but I am their first transitioning patient so they may be a bit apprehensive. Do you think if I bring a letter of Informed Consent it might help my chances of starting HRT sooner? Thanks in advance for the advice.


Darcy

There are two models. Informed consent requires a doctor or clinic that is willing to determine if you are a good candidate for HRT and if so, provide you with treatment. This process can be accomplished in about an hour and your blood will be drawn in the same session.  A Endo normally goes with the other options where a letter from your therapist is required before starting treatment. It will not be sufficient in either case for you to write your own letter because you are not following the procedure used in either case.

Not how informed consent works. They have to inform you of the risks/results/etc. and you consent. Not the other way around. A letter from a therapist or other mental health professional would be more effective.

I went to a GP who was recommended because she uses informed consent. I just made an appointment and told her my short version of my story. I am 54 with a long and sordid past. She said she was willing if labs came in good, but would like a letter to cover her butt. I don't know if she would have gone without it because my therapist, PTSD, wrote a nice letter for me. Took my first dose today in fact! I'm in San Antonio TX. With a less complicated past I'm sure she would have been OK, because I know other girls who used her without a letter. Support groups are a great resource. That's how I found mine.

I've had my treatment via informed consent at a Washington DC clinic specializing in LGBT care.  I received an explanation of the effects of HRT, orally and in writing, and signed an acknowledgement of having been so informed.  Then a blood screen, then the prescriptions.  It was painless and efficient.  I like the informed consent model.

WPATH 7 doesn't require a therapist letter for HRT and is effectively equivalent to informed consent, viz:

QuoteThe 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 Standards of Care outlined in section
VI);
4. If significant medical or mental health concerns are present, they must be reasonably well-
controlled.
...
Informed Consent
Feminizing/masculinizing hormone therapy may lead to irreversible physical changes. Thus,
hormone therapy should be provided only to those who are legally able to provide informed
consent. This includes people who have been declared by a court to be emancipated minors,
incarcerated people, and cognitively impaired people who are considered competent to participate
in their medical decisions (see also Bockting et al., 2006). Providers should document in the
medical record that comprehensive information has been provided and understood about all
relevant aspects of the hormone therapy, including both possible benefits and risks and the impact
on reproductive capacity.

Relationship between the Standards of Care and Informed Consent Model Protocols
A number of community health centers in the United States have developed protocols for providing
hormone therapy based on an approach that has become known as the Informed Consent Model
(Callen Lorde Community Health Center, 2000, 2011; Fenway Community Health Transgender
Health Program, 2007; Tom Waddell Health Center, 2006). These protocols are consistent with
the guidelines presented in the WPATH Standards of Care, Version 7. The SOC are flexible clinical
guidelines; they allow for tailoring of interventions to the needs of the individual receiving services
and for tailoring of protocols to the approach and setting in which these services are provided
(Ehrbar & Gorton, 2010).

Obtaining informed consent for hormone therapy is an important task of providers to ensure
that patients understand the psychological and physical benefits and risks of hormone therapy, as
well as its psychosocial implications. Providers prescribing the hormones or health professionals
recommending the hormones should have the knowledge and experience to assess gender
dysphoria. They should inform individuals of the particular benefits, limitations, and risks of
hormones, given the patient's age, previous experience with hormones, and concurrent physical or
mental health concerns.

Screening for and addressing acute or current mental health concerns is an important part of the
informed consent process. This may be done by a mental health professional or by an appropriately
trained prescribing provider (see section VII of the SOC). The same provider or another appropriately
trained member of the health care team (e.g., a nurse) can address the psychosocial implications
of taking hormones when necessary (e.g., the impact of masculinization/feminization on how
one is perceived and its potential impact on relationships with family, friends, and coworkers).
If indicated, these providers will make referrals for psychotherapy and for the assessment and
treatment of co-existing mental health concerns such as anxiety or depression.

My informed consent was very simple. I went to my GP and let her know that i was seeing a therapist and i wanted to transition. She gave me the disclosures and i signed them. She scheduled blood work, which quickly came back and i was started on T-blockers about 2 weeks later. She never asked for a therapists letter etc.

Isn't planned parenthood informed consent?

Quote from: LShipley on January 12, 2017, 06:21:22 AM
Isn't planned parenthood informed consent?

Yes, though HRT is not offered at all clinics.

More than is listed on their site though! Definitely ask your local branch

My doctor had me bring in a letter from my therapist and had me do informed consent. She did this as a way to make sure you completely understand what it is you want to do. To me I found it nice and a bit annoying, but it does make sure you completely understand the risks. I remember learning about a few things that I previously didn't know about such as things concerning the prostate.

Quote from: link5019 on January 12, 2017, 03:07:00 PM
My doctor had me bring in a letter from my therapist and had me do informed consent. She did this as a way to make sure you completely understand what it is you want to do. To me I found it nice and a bit annoying, but it does make sure you completely understand the risks. I remember learning about a few things that I previously didn't know about such as things concerning the prostate.

If she had you bring a therapist letter, she wasn't doing informed consent in the same way that is meant by this post. She had you sign a consent to treatment form, which is what all providers do for long term or surgical treatments.

The informed consent model skips the mental health stage entirely.

My first hormone doctor passed away long ago, so it won't do any good asking whom I saw. However, when I first went there, it was "no questions asked". It might have had to do with the fact that I already looked and behaved stereotypically feminine. He may have thought I was already on hormones.
It is probably more likely you could find out whom to go to through people you know in real life, than people on this site. Not many will risk being banned for telling you how to avoid WPATH to transition.

Informed consent was simple and easy for me.  The hard part is finding a doctor that treats trans patients at all.

I have informed consent HRT medications in my desk drawer.
I live in Washington State and am insured by Group Health of Washington, an HMO. They have an informed consent policy. In each separate Group Health medical clinic one of the physicians is considered the lead person at that particular location who handles transgender patients. Also, there is the Group Health of Washington Transgender Services Program through which any patient candidate has a telephone discussion lasting about one hour with a social worker who then becomes the transgender person's best friend. This social worker makes any requested referrals for any kind of Transgender service from HRT to voice coaching to surgery.

I passed that one hour phone conversation with flying transgender colors and I have the loving support of the best social worker in the world.

I had a simple one-time visit with the physician specializing in the transgender care for the local office, and I have my HRT prescription. I have my HRT meds for the first month costing me $18 out of pocket.

Now, it is all up to me when I take that first pill.  - - - It will be after I have the courage to approach my wife for the absolute necessity for HRT for my sanity. This is how my therapist is helping me. She is helping me find my confidence to have that feminine heart to feminine heart conversation explaining what gender dysphoria has done to me, and how beginning transition can help me out of my despair. I will take my first HRT pills as soon as my wife and I have that conversation.

To make a long story short, informed consent was simple for me in the Western part of the State of Washington.

Quote from: Lady Sarah on January 12, 2017, 09:50:14 PM
It is probably more likely you could find out whom to go to through people you know in real life, than people on this site. Not many will risk being banned for telling you how to avoid WPATH to transition.

While we tend to encourage some therapy, the TOS has no requirement for treatment under WPATH. People tend to accumulate emotional  baggage as the result of living with dysphoria so therapy gives them a good start in life. We have a number of known members who have bypassed the WPATH standards and that's between them and their doctors.

I'm also going for informed consent,i l already talked to my Dr.and she wants to do labs to see what my hormone levels are. I told her a shrink won't be of help for I know who I am and don't need a shrink to tell me who i am.

Quote from: Pandora Now on January 10, 2017, 08:51:21 PM
The reason I ask is that I have my HRT appointment coming up and I was curious what sort of success people have had with this route. My provider seems to be supportive, but I am their first transitioning patient so they may be a bit apprehensive. Do you think if I bring a letter of Informed Consent it might help my chances of starting HRT sooner? Thanks in advance for the advice.

I'd be prepared to educate them on what you want just in case they don't know what they are doing. Bring things like WPATH SOC 7 to show that its the appropriate thing to do. Bring HRT prescribing guidelines. Show them that you are fully informed of the consequences of what you are doing and have no other psychological issues. Make it easy for them.

Quote from: FTMax on January 12, 2017, 03:56:17 PM
If she had you bring a therapist letter, she wasn't doing informed consent in the same way that is meant by this post. She had you sign a consent to treatment form, which is what all providers do for long term or surgical treatments.

The informed consent model skips the mental health stage entirely.

Oh, well they called it informed consent at the office but that does make sense that it wasn't informed consent.

So, I did not use informed consent, but I used this clause in WPATH when I went to my Dr.:

QuoteIn selected circumstances, it can be acceptable practice to provide hormones to patients who have
not fulfilled these criteria. Examples include facilitating the provision of monitored therapy using
hormones of known quality as an alternative to illicit or unsupervised hormone use or to patients
who have already established themselves in their affirmed gender and who have a history of prior
hormone use.
https://s3.amazonaws.com/amo_hub_content/Association140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH%20(2)(1).pdf
Pg. 34

I told her that I had been taking hormones I had purchased online from Vanuatu (I was self-medicating) and I want to establish care and have my HRT prescribed and monitored for safety reasons.  I showed her the section in WPATH and she agreed to prescribe for me going forward rather than tell me no and leave me to use my illicit methods.  I have never looked back and never did informed consent, nor a therapist letter for HRT.  YMMV :)

Here in Ontario, the Ministry of Health seems to have adopted a simplified Informed Consent model, where family doctors are being encouraged to undertake complete control of ushering their patients along their gender transition path. This has been in response to the insane wait times at what was previously the only gender program provider in the province. Unless my HRT runs into complications, my GP doesn't foresee me needing to see an endo, or anyone other than herself for that matter. My GP will eventually be able to sign me off on my surgeries, as well. Very simple, with minimum stress. I read the horror stories of people in other jurisdictions, and I know how lucky we are in Ontario now. 

Quote from: Sofie L on January 17, 2017, 09:05:30 AM
Here in Ontario, the Ministry of Health seems to have adopted a simplified Informed Consent model, where family doctors are being encouraged to undertake complete control of ushering their patients along their gender transition path. This has been in response to the insane wait times at what was previously the only gender program provider in the province. Unless my HRT runs into complications, my GP doesn't foresee me needing to see an endo, or anyone other than herself for that matter. My GP will eventually be able to sign me off on my surgeries, as well. Very simple, with minimum stress. I read the horror stories of people in other jurisdictions, and I know how lucky we are in Ontario now.

Wish Alberta would move that way too... currently hanging out on the waiting list for our GIC. My GP is awesome and incredibly supportive so I wish he could do more to help me along.

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Informed consent is the only option around here. I've generally been very happy with, but my doctor isn't always accessible.  But that's as much because of the way the clinic operates as anything. I also have a GP who is trans friendly, but doesn't prescribe HRT.  Between the 2 docs, I'm pretty well covered. Other than hearing twice as often how I need to lose weight! 


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Quote from: link5019 on January 13, 2017, 04:48:09 AM
Oh, well they called it informed consent at the office but that does make sense that it wasn't informed consent.

Yes, technically, all HRT treatment is by "informed consent".  You have to sign off on informed consent in all cases, even after mental health evaluation by a psychologist as recommended in the WPATH SOC.  No doctor carries the kind of liability insurance that would be required if they didn't have you sign your informed consent.

The "informed consent model" being discussed here differs from the WPATH model in that there is nothing else except informed consent.

Quote from: Pandora Now on January 10, 2017, 08:51:21 PM
The reason I ask is that I have my HRT appointment coming up and I was curious what sort of success people have had with this route. My provider seems to be supportive, but I am their first transitioning patient so they may be a bit apprehensive. Do you think if I bring a letter of Informed Consent it might help my chances of starting HRT sooner? Thanks in advance for the advice.


Darcy

Sadly no. None in my area I've had to rely on self medding for my whole transition

I've gone the "Informed Consent" route. Knowing I was trans 50 years left no question in my mind and dealing with being trans for about as long also left no doubt as to what I really needed to do to take on the Trans-Beast.

Part of taking on the beast was seeing a therapist, mostly for all the associated baggage. I know many only see one just for the coveted "Letter" which I always saw as the "CYA Letter" for the doc. Nothing like having some backup if/when the court summons shows up in the mail

QuoteOh, well they called it informed consent at the office but that does make sense that it wasn't informed consent.

I think it just means you consent to whatever treatment you're getting.  They're making sure you understand, so as to avoid surprises and lawsuits.  I had that at the dentist recently, when I had a tooth pulled.

LOL  If that means researching what I could find about HRT and starting on it. Then telling my doctor and having him agree and getting a prescription and doing it right, then yes.  I did it a little backwards.
   The VA does work on an informed consent basis following the Wpath Standards of Care. They don't ague with you about being trans. They do confirm with you that you believe you are trans and provide services to facilitate your transition short of surgical or cosmetic procedures. I read something in their literature that they should get informed consent paperwork done but I haven't actually had it done yet.
   
   This isn't probably what the topic was intending but it is along those lines.

  Hugs,
    Jeanette

Quote from: JeanetteLW on February 26, 2017, 03:36:15 PM
LOL  If that means researching what I could find about HRT and starting on it. Then telling my doctor and having him agree and getting a prescription and doing it right, then yes.  I did it a little backwards.
   The VA does work on an informed consent basis following the Wpath Standards of Care. They don't ague with you about being trans. They do confirm with you that you believe you are trans and provide services to facilitate your transition short of surgical or cosmetic procedures. I read something in their literature that they should get informed consent paperwork done but I haven't actually had it done yet.
   
   This isn't probably what the topic was intending but it is along those lines.

  Hugs,
    Jeanette

If they are following WPATH standards of care, they are not simultaneously following informed consent. They are two different models.

Quote from: FTMax on February 26, 2017, 05:58:20 PM
If they are following WPATH standards of care, they are not simultaneously following informed consent. They are two different models.

  The VA does what it does. I may have been mistaken in regards to the WPATH reference as I cannot now find a reference to it. I did find a reference to informed consent.

This is from the VHA Direct 2013-003 Q&A
VHA DIRECTIVE 2013-003 February 8, 2013

A-3
8.  What are the guidelines for clinical care and the informed consent process?

a.  Effective clinical care for transgender and intersex patients ideally involves an interdisciplinary, coordinated treatment approach with special attention to the needs of the individual patient and collaboration among multiple specialties, notably:  gynecology, mental health, primary and specialty care, women's health, pharmacy, and urology.  For all treatments and procedures, informed consent and shared decision-making needs to be the basis for individualized care that weighs the possible benefits and harms, with an emphasis on the lowest (safest) dose to achieve benefits.   

b.  For treatment plans that include cross-sex hormone therapy, VA clinicians must, consistent with requirements of informed consent (VHA Handbook 1004.01), discuss the risks, benefits, and limitations of cross-sex hormone therapy with the patient.  Signature consent is not required for cross-sex hormone therapy.  Ongoing monitoring of treatment is required.

  Hugs,
    Jeanette