Susan's Place Transgender Resources

Hello all,

I have a few questions that can only be answered for me here. I've been looking into what all I'll have to do to start HRT. It appears that my state requires patients to go to a therapist to get their approval first before they can start HRT. The thing I don't know though is do I have to go to my regular doctor first to get a referral to a therapist, or do I just find my own therapist and go there first? I'm not exactly sure how that works.

On a side note, if I have to go to my regular doctor first that's kind of scary for me. He's the very best doctor on the planet and I've been going to him for 30 years. However I know that he's pretty religious and I HATE the thought of losing him as my doctor if he's not open to trans people. In my honest opinion I don't think it would bother him, after all, he is a man of science. But the thought of taking that chance is causing me some concern.

I've learned that some therapists refuse to recommend HRT if the patient isn't living as a female full-time. I haven't come out to anyone yet but you lovely ladies here at Susan's so far, and I don't think I'm ready to come out publicly yet. (In fact I know I'm not because I have to protect my daughter for the time being.) Do any of you know if living the full-time female requirement is true? If it is, what are my best options?

Should I just take the leap and go into the therapist's office dressed as a woman even though that would be extremely uncomfortable for me right now? Or should I search for therapists who don't require that step? Or is that requirement part of the law? I just don't know.

This is all pretty confusing for me. Supposedly most states are getting away from discriminating against those in the LBGTQ community, but having that requirement is discrimination in my book. To top all that off, I live in the state of Indiana and I'm sure you've heard how anti-LBGTQ the government is in this state. There are two other states I can get to with a fairly short drive, so I don't know if maybe I should try one of them first. Sadly both of those states are very conservative too, so it might not be any better in one of them either. Then there's the fact that if I go to another state I'd be pretty far away from my doctor.

Anyway any help you all can give me would be greatly appreciated!!

Lexxi

Has anyone had the chance to give this post some thought? I don't have anyone in my realm that would have any idea. Plus I'm not out to them yet anyway.

Any advice would be greatly appreciated,

Lexxi

The Real Life Experience is not a requirement for hormones. It is sometimes not even a requirement for surgery. There are some surgeons who will operate in some circumstances. It is a good idea to have some RLE, especially if you intend to dress uber-feminine after surgery.

For myself and many others, we still live a more or less androgynous life. The comfort of T-shirts and shorts is primary for me.

When you see your therapist, just be yourself, dress comfortably in whatever you want. A therapist in more concerned about what is in your head, not your wardrobe.

The process seems to depend on where you are and the services available. Some places don't require a therapist visit at all, only an informed consent from the patient. I think it is wise to talk to a therapist as there can be so many different things to consider. My psychologist required me to convince her that I was trans and was aware of what I was. It should not make a difference how you present, but it is important to be comfortable to express yourself fully.

My psyche started off by telling me it usually takes three 55 minute sessions (@$200/session) to make a diagnosis, and asked me to tell her my story. At 40 minutes she stopped me and said she was convinced she was talking to a woman, and I should have transitioned many years ago. She asked me some control questions to satisfy standards and wrote me a referral to an Endocrinologist. I did have to get a referral from my GP so I could claim the cost of Psychology (I'm in Australia), but I found a new (female) GP as I wasn't comfortable coming out to my regular male GP.

Since then I've had to come out to doctors, receptionists, pharmacists, and I'm pretty sure the pathologist knows why I am having my oestrogen levels checked regularly.

Check your local requirements and services (my GP did not have a clue as I was the first TG patient she has had) and get the ball rolling!

Allie

Your questions really need to be addressed according to what country and maybe where in that country you are. In Australia the process is basically very straight forward nowadays with informed consent pretty well basic for most clients. In the USA it varies from State to State, in Europe it varies from country to country and in the UK it just seems a long slog that works well but it is a very long slog if you can't go private. In Asia it appears not generally well medically supported.

If you are young it is (obviously) more difficult. If you have any mental health issues it is more difficult.

I - just personally - would recommend help from a well qualified and experienced gender therapist and preferably a medically qualified psychologist or psychiatrist. That opinion is based on personal experience and from many of us carrying PTSD issues from trying to live our difficult lives. YMMV.

Hi Dani,

I will be joining the ranks of the T-shirts and shorts class. I only wish I could dress uber-feminine. Unfortunately I'm an overweight giant and that just wouldn't look good. Even if after I lose all my unwanted weight, which I'm working on now, that won't do anything for my 6'4" frame. Maybe some day science will figure out a way to give me the skinny 5'4" body I'd like to have. Sadly I'm afraid I'd be too old to enjoy it by then. Ha ha ha...

Thank you for telling me about the best way to handle the therapist!! I figured it would be better to just be myself, so I couldn't understand why they'd require me to step outside my comfort zone right out of the gate.

Lexxi

Hi Allie,

Unfortunately I'm in the U.S. and my state requires a note or diagnosis from a therapist. Which I really don't mind going to see, so that won't bother me. I had just read somewhere that nearly all therapists require their trans patients to be "living the life" before they would give the recommendation for HRT. I've been researching therapists that specialize in gender identity. Sadly there aren't any I can find in my general vicinity. Or I should say if there are I'm having trouble finding them. I think the closest one I found was a 2 hour drive away. But hey I'll drive there if that's what it takes.

Thank you so much for your advice!! I'll be continuing my search today. Hopefully I'll get lucky.

Lexxi

Try looking for a provider through WPATH

https://www.wpath.org/provider/search

At least they should know what they are doing.

Hi Cindy,

Thank you for the advice. I don't think I have any type of PTSD because I've kept my true self hidden for my entire life. But she's screaming to come out and I'm going to let her. I suppose I have had some mild depression though because I've never felt like I could be myself. Hopefully the therapist will see the need for me to start HRT.

You mentioned age but I think I'm fine there as I just turned 50 a couple of months ago. I can't wait to get this process started. I feel like I've waited entirely too long to do this.

Thanks again,

Lexxi

WOW Cindy,

Thank you for that link. Apparently the reason I was having trouble finding a therapist was because there's only one in a hundred mile radius. She treats all kinds of people, but she specializes in life transitions. Her webpage says she's transgendered allied. She sounds exactly like the kind of therapist I'm looking for.

Unfortunately she's running a 2 month long waiting list right now, so that's gonna put me a little behind where I want to be. But hey I'll do whatever I have to do to get started. I just sent her an email to get the ball rolling.

Thank you so much for sending that link!!

Lexxi

Quote from: Lexxi on May 23, 2019, 06:53:48 AM
Hi Allie,

Unfortunately I'm in the U.S. and my state requires a note or diagnosis from a therapist. Which I really don't mind going to see, so that won't bother me. I had just read somewhere that nearly all therapists require their trans patients to be "living the life" before they would give the recommendation for HRT. I've been researching therapists that specialize in gender identity. Sadly there aren't any I can find in my general vicinity. Or I should say if there are I'm having trouble finding them. I think the closest one I found was a 2 hour drive away. But hey I'll drive there if that's what it takes.

Thank you so much for your advice!! I'll be continuing my search today. Hopefully I'll get lucky.

Lexxi

Lexxi,

I'd read that RLE (Real Life Experience) is a requirement in places like the UK (please correct me if I'm wrong) but that wasn't the case for me here in Florida. I did show up at my first therapist session wearing all women's clothing, but very androgynous. Just women's jeans and a white button down women's shirt. Not even a bra at that point. I had also read that it would take at least three sessions before I would be prescribed HRT (if at all, depending on the therapist's diagnosis), but as with Allie, by the end of the first session I had an appointment with an endocrinologist. Apparently I was quite convincing.

I agree with Cindy that you really need to seek out a therapist experienced with gender issues. You do not want to be the first trans person a therapist works with, not just for the sake of an informed diagnosis, but also for any future insurance requests. If you can find one who has a PhD in psychiatry or psychology, that will also smooth the way in the future. I'll be writing about that on my own thread...

Good luck, girl.


Stephanie

In most places, you do not need a doctor's referral to see a therapist.  I chose to get a referral from my doctor because our insurance would pay if I was referred, but not if I self-referred.  When my original therapist retired and I needed another one for my GRS letters, I self-referred.

Most therapists and endos will follow WPATH guidelines.  Those suggest that you should see a therapist to ensure that you have a good understanding of what HRT will do to you, and to ensure that there are no mental health issues that would cloud your judgement. 

There is no requirement in the guidelines for RLE before HRT.  That requirement used to exist, and still may in some countries, but it is not supported by the WPATH guidelines.  Anyone who still has that requirement would be considered unprofessional.

As for what to wear to your first appointment, just wear whatever makes you comfortable.  I went to my first one in jeans and a women's T-shirt, with silver ear studs.  Basically in guy mode, but femmed-up a bit.  By the last one, I was in full girl mode, with a skirt and top.

Quote from: Lexxi on May 23, 2019, 07:12:24 AMUnfortunately she's running a 2 month long waiting list right now, so that's gonna put me a little behind where I want to be. But hey I'll do whatever I have to do to get started. I just sent her an email to get the ball rolling.

Unfortunately, this is something we all have to have to get used to. Two months is lightning speed compared to some places. In the UK and Canada it can take as much as two years to get an appointment, and surgeons like Marci Bowers have a four year waiting list. Nothing happens fast in transition. I hope you have the patience gene.

Keep a good attitude and keep chipping away at it. It does happen! I started my journey almost exactly two years ago, and by the end of this year I will consider myself done. I've been told I'm moving incredibly fast, but it feels like for-ever to me.


Stephanie

Hi Steph,

Thank you for the information! I just looked up the therapist that WPATH recommended. Apparently she's the only one near my vicinity. Her website says she specializes in Life Transitions, which I would think that Transgender issues would certainly qualify. She's Transgender Allied too.

Her website also says she's been a member of WPATH since 2017. Oh and she's a Psychological Associate, MA, LPA. Sadly she must not have her PhD though. But it looks like she specializes in Trans patients so I feel comfortable giving her a try. It makes me feel confident that WPATH recommends her.

I didn't know Trans issues had such long wait times. I'm glad to know though that 2 months is lightening fast. That makes me feel better after worrying about a 2 month long wait. lol

It's good to know that you're almost done with everything. That must make you giddy!!

Thank you again for the help and advice. I'm forever in your debt.

Lexxi

Interesting to note that a couple of the posters went to their first therapy session wearing women's clothing but presenting as male. I have to admit that I did the same! It must be a common thought that we have to convince the therapist we are trans, and need something external as evidence. My sessions since have been straight after work, so I was in my work clothes.

Allie

Hi Kathy,

Thank you for the advice and the suggestions. I think just to be on the safe side I'll get myself a new pair of jeans and a new blouse too. Oh and I'm going to be sporting a new earring also, because I'm going to go get my right one pierced in the next day or two. I already have the left one done. Now I'll be matching.

I'm also going to take your advice about getting that referral. I already know my GP will give me one because he's the very best doctor in the whole world. I've never told him about what I've been hiding and I'm kind of scared to. But it's going to have to be done eventually, so I'll call him and let the chips fall where they may.

Once again thank you for the advice,

Lexxi

Allie maybe the heard the same thing that I did. I think every article I found said that if you weren't presenting as female they would refuse your request for the letter. I'm glad that that appears to be false though. I wonder if some anti-trans group put that misinformation out there to scare people. Or I suppose they could have been older articles. I really don't recall looking at the dates they were published.

Well ladies I have to say that I feel much better. With your help, advice and guidance I feel like I can get this done. And according to Steph it's going to be lightening fast too, which I really like. I knew you all wouldn't let me down.  :)

Lexxi

There used to be , and maybe still are, some reputable online therapists. I'm not sure how to find them but maybe someone else knows.

Quote from: Lexxi on May 23, 2019, 07:36:04 AM
Hi Steph,

Thank you for the information! I just looked up the therapist that WPATH recommended. Apparently she's the only one near my vicinity. Her website says she specializes in Life Transitions, which I would think that Transgender issues would certainly qualify. She's Transgender Allied too.

Her website also says she's been a member of WPATH since 2017. Oh and she's a Psychological Associate, MA, LPA. Sadly she must not have her PhD though. But it looks like she specializes in Trans patients so I feel comfortable giving her a try. It makes me feel confident that WPATH recommends her.

I didn't know Trans issues had such long wait times. I'm glad to know though that 2 months is lightening fast. That makes me feel better after worrying about a 2 month long wait. lol

It's good to know that you're almost done with everything. That must make you giddy!!

Thank you again for the help and advice. I'm forever in your debt.

Lexxi

The PhD requirement comes in if you decide some day that you want GCS. Who requires what varies all over the map, but my insurance company requires two letters from therapists, and at least one of them has to have a doctorate. For various reasons, I've worked with four different therapists over the years, and in the end I had to find another who had that special designation before I could move forward.

Giddy? I still fight fear and doubt issues, but that's just my inherent personality asserting itself. A lifetime of pessimism, living in the wrong shell, is a hard habit to overcome. Logically, I know that I've been lucky with the way transition is going, but emotionally I still live in fear of being misgendered, despite it not happening for about a year. I've been belittled by those who are adamant that it shouldn't matter to me, but it does, very much. Despite all that, by the end of this year (fingers crossed) I will have finished all the name and gender change paperwork, had two rounds of FFS, and will have had GCS. "Giddy" might describe how I'll feel then. Right now I only feel nervous anticipation.

As for being in my debt, I'll PM you with my address so you can send the check. [emoji16]


Stephanie

Quote from: steph2.0 on May 23, 2019, 07:13:32 AM
Lexxi,

I'd read that RLE (Real Life Experience) is a requirement in places like the UK (please correct me if I'm wrong).

Stephanie

It usually is for NHS in UK but many of us here including me go private meaning RLE not necessary for HRT. Coincidentally I am starting RLE shortly.

I wish you and Lexxi every happiness and success.

Hugs

Pamela

Quote from: Lexxi on May 23, 2019, 07:56:32 AM
And according to Steph it's going to be lightening fast too, which I really like. I knew you all wouldn't let me down.  :)

Uh oh. I am so in trouble now. I'm trying to backpedal furiously, but the chain just came off the sprockets.



Stephanie

Steph,

When you mentioned sending a check I thought what in the world is she talking about. I had to jump back through all those posts to see what you meant. You got me good...and the checks in the mail. lol

I hope you didn't take the giddy comment as something negative. I meant it only in a good way. You always come across as a strong woman to me, so I hope you can let those feelings of insecurity fly right out the window. From my perspective looking in I don't see where you'd ever need to have any fear or doubt. You're a role model to me.  :)

With that said you're allowed to feel anyway you want to and no one should ever belittle you for the feelings you have. They're yours to do with as you see fit.  :)

Quote from: pamelatransuk on May 23, 2019, 08:26:51 AM
It usually is for NHS in UK but many of us here including me go private meaning RLE not necessary for HRT. Coincidentally I am starting RLE shortly.

I wish you and Lexxi every happiness and success.

Hugs

Pamela

Good luck with your RLE Pamela!!

xoxo

Lexxi

Quote from: Lexxi on May 23, 2019, 09:42:11 AM
Steph,

When you mentioned sending a check I thought what in the world is she talking about. I had to jump back through all those posts to see what you meant. You got me good...and the checks in the mail. lol

Whew. Maybe I can eat this month!

QuoteI hope you didn't take the giddy comment as something negative. I meant it only in a good way. You always come across as a strong woman to me, so I hope you can let those feelings of insecurity fly right out the window. From my perspective looking in I don't see where you'd ever need to have any fear or doubt. You're a role model to me.  :)

Negative? Oh, heck no. I'd love to feel giddy about it all, and at times I do have to pinch myself when I realize how far I've come - like just today at lunch when the waitress asked me, "And what would you like to order, ma'am?" You'd think I'd be used to it by now, but I still get that little thrill when it happens. And if I give myself a chance to stop and think about it - really think about it - I literally shiver and have to hold back a squeal of joy over the fact that some time in September, I'm finally going to have the vagina I should have been born with. I guess that qualifies as giddy.

I thank you so much for the compliments. Looking in the mirror I still see so much of him (though he's receding in memory), but knowing that others see what I hope they see makes me feel so good. As for being a role model, I was going to say something self-deprecating like, "what kind of roll, egg or jelly?" but instead I'll be serious for a second. I have so many role models here, girls like @SassyCassie, @Kendra, @Laurie, @Michelle_P, @Happy_Moni, @Anne_Blake, @Jessica_Rose, and so many others I risk offending by not naming. They saw me through good and bad times, have all become good friends, and have shared real-life experiences with me. All of them have accomplished so much, are most of the way through, if not completely finished, with transition, and have stuck around to help those of us following behind. How could I not stay here to pay it forward to those like yourself who are just getting started? I feel it's an obligation, a privilege, and a pleasure to be here for you.

As for being strong, those who've known me have heard me say this before (there she goes again...), but since you're new here, I'll repeat it: I used to dismiss those who called me brave for going through this. I'd tell them it wasn't bravery, it was desperation. But then I ran across a quote attributed to John Wayne: "Courage is being scared to death, but saddling up anyway." By that definition, I guess I - and all of us transitioning - must be pretty courageous.

QuoteWith that said you're allowed to feel anyway you want to and no one should ever belittle you for the feelings you have. They're yours to do with as you see fit.  :)

It didn't surprise me to run across some here who are quite militant about being outspoken and out front in the battle for our rights. I'm so glad there are people like them. What I didn't expect was a few of them who are just as militant that everyone should take the same attitude. As you say, we all have the right to approach our lives as we see fit. After fifty years of turmoil I just want to live a simple and quiet life as I should have all those years. I sit with those who support quietly from the sidelines. And I vote.


Stephanie

Well as one of those people just starting down the path, I surely appreciate you sticking around to help all of us baby trans girls get started.

I just read that little bio thing on your timeline. I'm impressed that you're getting Marci Bowers to do your surgery. I watch that show All About Jazz and Marci is one of the doctors who did her surgery. She seems like a very impressive doctor. Jazz and her family really seem to love her.

You can also try the resources link provided here in this forum: 

https://www.susans.org/forums/index.php/topic,243630.0.html


Chrissy

Thank you Chrissy!! That site seems to work very well.

Quote from: Lexxi on May 23, 2019, 09:44:07 AM
Good luck with your RLE Pamela!!

xoxo

Lexxi

Thank you Lexxi. I appreciate that.

Hugs

Pamela

Quote from: steph2.0 on May 23, 2019, 07:19:41 AM
In the UK and Canada it can take as much as two years to get an appointment

I live in Ontario and started HRT just over 5 weeks ago.  Here, informed consent is available, no therapist required.  There was a long wait for the endocrinologist, but that was mainly due to a dramatic increase in business after the protocols were changed 3 years ago.  It took 5 months from when I asked my doctor for hormones, until I was able to see the endocrinologist.

Quote from: AnneK on May 24, 2019, 05:57:20 AM
I live in Ontario and started HRT just over 5 weeks ago.  Here, informed consent is available, no therapist required.  There was a long wait for the endocrinologist, but that was mainly due to a dramatic increase in business after the protocols were changed 3 years ago.  It took 5 months from when I asked my doctor for hormones, until I was able to see the endocrinologist.

That's great to hear, Anne. I'm working off of anecdotal evidence. Others have mentioned the wait was crazy long. Any wait at all is galling, but I'm glad it isn't as bad as I thought.


- Stephanie

Quote from: steph2.0 on May 24, 2019, 08:30:16 AM
That's great to hear, Anne. I'm working off of anecdotal evidence. Others have mentioned the wait was crazy long. Any wait at all is galling, but I'm glad it isn't as bad as I thought.


- Stephanie

What's really great is that the delay was caused by trans care becoming much more available, with the protocol changes.  My endo is currently helping to train others in this field.  So, perhaps even less wait time will soon be the norm.  In Ontario, the protocols were changed in March, 2016.

Here's a little update about my impending therapist visit. I called the office of the therapist WPATH recommended in my area. I spoke with her receptionist and was told that she wasn't taking new patients at this time, but he would be happy to get me in with one of the other clinicians. Once I told him why I needed to be seen he said that that clinician wouldn't be able to give me the needed letter.

He took pity on me though and told me to contact the original therapist by email. He pretty much told me what to say to get her to change her mind and add me to her schedule. I sent the email and have yet to hear anything back yet. I'm keeping my fingers crossed that she'll get back to me soon, because if I can't get in with her I'll have to travel to the next largest city near me and that's a two hour drive away. It really sucks living in the bible belt of the U.S. where people from the LBGTQ community are under-served or face outright discrimination on a daily basis.

Thank you all for joining in this discussion with me, and thank you all very much for the great advice,

xoxo

Lexxi

Lexxi,

I f you can't get the WPATH recommended therapist and are looking at a 2 hr journey, do another search and see who will do Skype sessions or distance therapy sessions. If you don't have any underlying issues (and be honest with yourself and your therapist about that) you are probably looking at a maximum of 3 sessions. The old saying was, first is to tell the therapist what you want, the second is for the therapist to tell you what's going to happen, the third for did you and the therapist understand the first two.
I do understand that some places are basically HRT on demand but I don't think that you can get letters from them if you want to go for surgery - which is entirely up to you.
I'm also basing my comments on Australian experience and long ago I have to admit.

Thank you Cindy! I might check into that if this therapist doesn't pan out. I don't think it's a bad thing to talk to a therapist about what I'm feeling, thinking, etc...so I'm going to be totally honest. I just want to make sure that I'm with a WPATH recommended therapist no matter what. I wish there were a professional gender/sexuality clinic in my vicinity. That would make things so much easier.

xoxo

Lexxi

Okay ladies I finally heard back from that potential therapist. She said she would be glad to fit me in her schedule...but can't do it until August or September.

She said if I would like to be seen sooner than that she had a short list of other therapists she trusts, and they're "trained in working with people who are looking for gender affirming therapy, and/or may be able to write letters for gender affirming hormone replacement therapy." Even though they're trained in gender affirming therapy none of them are WPATH recommended.

Do you all think I should wait the 3 or 4 months for the WPATH recommended therapist, or should I talk to one of the others on the list? If your recommendation is to talk to one of the other therapists I'll be asking upfront if they're able to write "the letter" so I won't be wasting my time.

What are you thoughts?

xoxo

Lexxi