Susan's Place Transgender Resources

In a reply to her poll on Free SRS, Annie Social raised a very good topic for another poll.  So what do you think?  Reasonable or needless?

Great idea Annie:)

Steph

I think it depends on the original gender. I would say for FtM's particularly, it's a needless obstacle. Testosterone makes such huge changes in your presentation and voice that without it, it's near impossible to pass unless you're very young.

Perhaps it makes more sense for MtF's because the physical and voice effects of estrogen aren't as dramatic and there is a need to really work at presentation in addition to hormones.

Dennis

I'd probably answer that differently each day of the week.

Seeing as I used to hate Therapists, I would have said it was just a way for them to control us and make money off of us.

Having gotten a good therapist, I have softened my viewpoint.  I think it is important to be cautious, but, we should still have our free will.

I think we need another option somewhere in the middle.  I can't give a yes or no answer.

Sarah

Oh boy.  I was just thinking about this topic a few days ago, or at least a related one.  Let's just call it SOC vs. IRS. 

The SOC requires a transsexual to go through costly hormones, therapy, electrolysis and 1 year RLT before you are even allowed to have SRS. 

The IRS says that SRS is "just cosmetic" and because of this, they won't allow a deduction.

The irony in this is that if it were not for all the expensive requirements for SRS that you have with NO OTHER "cosmetic" procedure, needing a tax deduction wouldn't be as big of a deal.

You could argue that without all those requirements, one could not live as effectively as a woman.  However, there are certain individuals (not me) who would like SRS because of genital disgust, but choose to live life as a male. A person who does not go through through RLT may make a bad choice to have SRS and regret their decision.  However, there is such a thing as personal responsibility.  If a person choose to have too many facelifts, they can be stuck with an "ugly face".  However, that is their own choice.

How many transsexuals are there who had genital disgust and could not bear to wait the required amount of time or jump through all the required hoops and ended up killing themselves?  How many people went through all the hoops and regretted thier SRS decision.  I bet the number of the first group is much larger than the second. I think RLT should be an optional albeit recommended part of the SOC.

Melissa

Thanks again, Stephanie!

Dennis, a question: Are you saying that a real life test is required before testosterone is made available? I've never heard of that; I've only heard of a RLT being a prerequisite to surgery.

Melissa, I pretty much agree with you. There have to be some sort of sfeguards; god knows there are enough crazies in the world to really make a mess of things if SRS were available on demand. But I'm not wild about the idea of 'therapist-as-gatekeeper' either; there shouldn't be any sort of an adversarial relationship between a therapist and patient, and that's exactly what is made possible by the current system.

I'm not sure what the answer is; there may not even be an answer that is equitable to all and effective at the same time.

Annie, it's one of the recommendations of the HBSOC, RLT or three months' therapy. That's because of the huge changes you get with testosterone, many of which are irreversible.

It's fairly relaxed in practice, though, because of the difficulty passing without testosterone. Most will only require certification by a qualified therapist. Originally, before it was relaxed, I believe that a year's RLT was required. And I have heard of some treating professionals requiring it.

Dennis

Being a Libertarian (but not in all things), I would prefer it if therapy was not required for SRS.  As Melissa points out, therapy isn't required for crazies to have multiple face jobs (like Michael Jackson).  I've always thought that, if I wanted to go in and buy Propecia by the tubfull, I should be allowed to do it.  Instead, we have two things:  (1) doctors we have to go to to get the prescription and (2) well-paid pharmacists who dole out the pills to me at inflated prices.  Am I really going to want to overdose on Propecia?  Even worse is my allergy pill, Singulair.  The system is based on the idea that we're all stupid and would overdose.  I could overdose on Drano or paint thinner but I don't notice anyone being a "gate keeper" to a lot of household items.  Unlike a lot of people, I would go to my doc and tell him what I'm thinking of taking and ask his advice.  If he said, "No, that would be dangerous," that'd be the end of it.  If I took a drug, I would expect him to monitor whatever might go wrong.  We would, in essense, work WITH each other for my own good.  Some would not be as cautious as me, I suppose, and for that reason, there are the gate keepers for pills...and SRS's.

Libertarians place the responsibility of things on the INDIVIDUAL.  Of course, in our "I'm a victim" society, it's hard for any business to exist if people are suing it because of the individual's bad decision.  And so we come to the REAL reason for therapy - SRS doc's presumably like it because it shifts the blame from them to the therapists.  The odd thing about this thinking is that I haven't heard of many (or any?) therapists being sued because they "green-lighted" an SRS.

I guess it's fortunate that tests, therapy, and drugs weren't required for my craneo-fascial surgery with Dr. O.  But after all, he was just messing around with something EVERYONE SEES - my face - as opposed to something no one sees (because it's hidden under my clothes).  And, to reiterate the point of one of my posts, contrary to popular notions, I COULD go back to living as a man if I wanted -- some "top" surgery and, essentially, I'd be there.  So my bottom isn't perfect as a man?  So what? 

Yes, I would have loved to have skipped the gate-keeper therapists (tho mine was nice, too).  If others want therapists, I certainly wouldn't discourage it (it should be optional) but, for me, I knew what I wanted and I'M THERE.  But there's a lack of personal responsibility in our society so I readily understand why the system is as it is.

Teri Anne

I think you have to get some experience tot be sure your choises are real.
So some kind of Real Life Experience you should allow yourself but putting it as a Real Life Test before the genderteam allows you to get SRS is to much of an obstacle I think.

For instance I did my research before I went to a genderteam and in the experiences I made sofar I am sure that I have made the right desicions. So for me the Real Life Test will be an unneccesarry obstacle due to the time involveld.
The testing before you get your hormone therapy is much more an adviseble obstacle. However it will take me half a year before I can start my HRT and I wished it could been started half a yaer ago.

next april 13 I will have to make my test battery at the genderteam.

Greatings to you all,   Mariska

I did a little RLE before I started hormones.  I did it as kind of practice and had no problems.  It was actually a little more forgiving than I had expected.  You don't need to act like a "perfect" woman (whatever that is) to pass.  Either I was not clocked or nobody cared.  Either way, I can only look and act better than I did back then.  One other note, transition should not just be about becoming a woman.  It is more about becoming yourself.  I'm not going to try and be a "perfect" woman, I'm just going to be me.

Melissa

Steph,
I think I may, in rereading my previous post, have gotten sidetracked from the main query of your post.  I addressed therapy and drugs when, in actuality, your question in starting the post, was whether RLT was "a reasonable safeguard or a needless obstacle?"  I feel RLT is indeed necessary -- the hardest problem TS's will face will be how spouses, relatives, friends and society will react towards us in transition.  If you only present yourself as your "true self" when away from people who know you, you are getting an invalid test as to how you're going to get along in your PRESENT world.  If your aim is to move away from everyone you know, I suppose less time (than 1 year) would be needed for you to gauge how you "pass." 

Of course, one of my theories/worries is that some TS's enter into transition thinking that it's gonna be exciting and fun to dress as a female.  I truly believe that even the die-hard TS's of that persuasion will get bored over time with dressing female.  Like I've said in other posts, a new car is a NEW CAR!  But an old car is just transportation.  So, in a sense, the longer the RLT, the longer you have as a test on your own PERSONAL SATISFACTION with why you feel you need to transition.  In the end, YOU have to be happy with your decision, not the "gate-keepers."  In my own situation it was a "reasonable safeguard" for my own happiness.

Teri Anne

If a person needs to transition they will regardless of any barriers.

If a person is rejected by a therapist they'll just refine their story for the next one.

Personal responsibility!

Leigh

hahahahahahaa, now I know  I'm coming apart.  RLT, is it reasonable or a waste of time?  Well, I guess all I got to do is determine what exactly it is I'm trying to accomplish so I'll get some small clue as to what this whole pointless process is all about.

With no bit of experience or brains I'll have to assume that at some point one will have to try "Passing" as a female and will spend more and more time femmed out to convince people they are the other sex.  At least it would seem to be the type of thing one would do .......

and regarding how to handle the social observations of some of the observers, well, there is always the fact that thier eyes arn't all that good past a few feet and who the hell knows about thier hands.  Personally I don't have a lot of trust in the eyes, ears and touch of most of those hind legged types trouping around out thier.  If they think they see hear or feel something then it has to be real, right?

anyway, would seem to me that the closer to being a real ideal opposite core individual you are the more you will be spending time looking as much as possible like one.

Yeah, I believe in finding all the answers to any brain dead hunk of lunk that sees you perfectly as what you claim you aint,  we can't all be brain dead ya know, after all this is the 21st centry.

Terri

I think that RLT is a reasonable safeguard. If you can't live your life as the gender you know or believe yourself to be, regardless of physical deformity then what do you think will be accomplished by SRS. It is a litmus test which is more important to yourself rather than the gatekeepers. If you cheat than you are only cheating yourself and yourself is what it is all about. To be sure some may cheat and litigate later, that is why we have the gatekeepers, to insure that litigation can be turned away because the people we depend on to complete our transition are protected and so available for others to transition. Despite the inconvenience it may impose on our wants and desires, we have been there, and have a responsibility to insure the future availability of this process to those who come after us. Just my two cents.

Cass

I don't standunder.

Why should I/we/someone pay for permission?

Or are we simply a cash cow?

Leigh

I agree to some extent, Cass, but again, I think you're only looking at the MtF view. From the FtM point of view, you're simply not going to pass without T unless you are young and also look masculine. At my age, it wasn't going to work and my career would have been threatened.

I also got chest surgery before I started living as male because of the same thing. It wasn't going to work without extremely uncomfortable binding and I couldn't function at work with my tits strapped down like caged birds.

As far as bottom surgery for FtM's, well most of us don't go for it, and those who do, don't go for it until the dysphoria hits an absolute peak even with living as male full time.

Also, there aren't psychological disorders (that I know of, although it may become more prevalent with the growing public awareness of FtM's) that mask as FtM. There are some that mask as MtF.

In short, I have not heard of a single case of regret from someone who's started the FtM process. I have heard of cases of regret from people who've gone through the MtF process, and RLT has not exposed those cases. On the other hand, RLT may have prevented more cases of regret than we do see and those who get through RLT masking a psychological disorder are the rarity.

I think the guidelines were developed with MtF's in mind and were later adapted to FtM's and the fit is not very good.

Dennis

Personally I believe that the RLT is a "Reasonable" safe guard for the reasons the SOC intend it to be.  Before I started my own RLT I was of two minds on this and still am for that matter.  On the one side there is that part of me that says "Who the hell are they" to tell me what is, and what is not best for me, and then on the other hand there is the need to ensure that I am not making a big mistake that I do in fact know what I'm doing.  We face tests all our lives and while we all think that we know much, tests have a way of reavealing those things we don't know.  For example driving tests to get our license so that we don't endanger ourselves or others to mention just one.  But it still gets my back up to think that I am applying for a job as a woman, here are my credentials and qualifications an here are my "Test" results...  May be it's that word "Test".

My RLT has been worth every moment, I have not seen it as a test but as a confirmation to myself and others (not that I care about others) that I am the woman I know I am.  And I believe that it is a good method of weeding out those who think it would be "neat" to be a woman, those who would like to "try it out", those who think they can "pull it off", the wanabees etc...

I would recommend that those who venture on this road read the SOC thoroughly as you may be surprised at what is contained in them and what the Standards recommend.  Jumping through hoops, barriers, hurdles, keepers of the gate...  In the words of a famous military leader "Nuts".

Steph

Dennis, I agree with you if we're talking about a real life test before being allowed hormones, especially in the case of FtMs. All of us, MtF or FtM,  need the all the advantages we can get before living full-time.

For bottom surgery, though, I don't have a problem with the RLT prerequisite; in that case, I agree with Cass. In a society in which SRS was available on demand, it would quickly become unavailable as lawsuits by people unwilling to take responsibility for their actions would drive insurance coverage for the doctors who perform it to unaffordable levels.

After years of supressing my true nature and denying even to myself who I really am I do not trust myself to make decisions about irreversable treatments such as SRS without long and careful consideration, preferrably with the assistance of a professional to help guide and advise me.  I am too convinced, from all of my life experience, of many people's ability to fool themselves.

I also think that changing something as life altering as my gender presentation can unearth other issues that may have been buried by the same tactics I used to bury my self.  I think dealing with those things, should they come up, before surgery would be in my interest too.

So, I think that RLE is an absolutely reasonable safeguard for most people.  The SOC provide for flexibility on the part of the caregiver in the rare cases where the person is absolutely ready to go in a short time.  It does happen but in the main, I think that taking the time to prove yourself, to yourself more than to the caregiver,  is a good thing to do.

helen

I might be wrong about this.  But I thought in Thailand you can get the operation with only a doctor consultation?  They make the call there and then?

Yeah... it means going to Thailand for the op.  But it does make it available without all the hoops if you are truly desperate?

Erica,

I believe this varies from doctor to doctor. Here's a link to the policy at Dr. Suporn's clinic:

http://www.supornclinic.com/HTML/Scheduling/protocol.html

Quote from: Erica on April 08, 2006, 01:50:03 AM
I might be wrong about this.  But I thought in Thailand you can get the operation with only a doctor consultation?  They make the call there and then?

Yeah... it means going to Thailand for the op.  But it does make it available without all the hoops if you are truly desperate?

Annie is right although each clinic follows the SOC each has their own list of prerequisites based on the Standards they require their patients to follow before permitting surgery.  I imagine there are chop shops out there that will perform the same service without the patient following the SOC but I believe that you would need to be "Truly desperate" to risk those.  Being "Truly desperate" can lead to acts of desperation, which can lead to mistakes and regret.

Steph

I think you got it a little confused Erica.  All the decent docs in thailand require the letters from your shrink the same as any doctors in america/canada do.  Same stuff, just a lot cheaper.  Most of them can put you through thier own psychs there though if you lack what you need.

Take it from the not so humble though, if you can't make it through RLT, you will be dead meat if you had SRS and went from there.  Just the simple opinion of one who walks through a lot of stuff most won't come close to.

Personally it's all about as hard to get through as your mood this morning.

Terri

Bumping up to my own RLE (or started already? ^*shrug*) I find there are just too damn many layers. RLE tends to help strip some away and make us realize a few things, I think.

The extents that are wanted, however, I think are unnecessary. By and large we are not a dense group.

Quote from: Leigh on April 06, 2006, 11:03:26 PM...
Or are we simply a cash cow?
...

^*chortle* Well, what do you think? ^*wink*

thank you again for a good thread, Stephanie.
I was thinking hard about this very thing. Like Teri Anne, I am a Libertarian about some things (and a complete pinko about others), this being one. Individual is ultimately responsible, ya pays yer money, ya takes yer chances.

What is a Real-Life Test for me? I do not pretend to be other than I am. Because I am an artist, I don't function in any typical way in society anyway. Working and living as a woman? I am, have been all year. I need to prove this to 'the gatekeepers' to complete this journey: this involves some strenuous hoops to be jumped through, which are (understandably, in a completely pragmatic cost-to-benefit ratio for the surgeons and ultimately the society they must function in) in place to protect people from themselves.
Re: these hoops. The changes I am going through, some days I will be perceived the one way, some days this is not possible, clearly male by default - the effects of the 'booster shots' they gave me to ensure that puberty went according to outward genitalia are undeniable. Until I can afford and complete electrolysis for instance, acceptance as strictly female by anyone but the MOST enlightened and sensitive individuals, is a joke. (Despite the existence, and cafe ownership, of Bearded Ladies in SF.)
I am not a Believer. I do not have Faith in doctors, or therapists, or "Professional Help". "Professional" means one thing for certain: they require being paid. Handsomely, in these professions, Drs, Therapists &c. This tends to corrupt any process.
[The person I live with is a Marriage/Family Therapist interning, soon to open his personal practice; he does not 'believe' either. There are Believers in the picture sometimes; this contrast, of an astute person that has the ability to stand back from the 'trade', versus the ones with belief and faith (who tend to be pretty messed-up btw) is quite revealing, and a source of insight for me.]
Now one of the hoops involves supposedly some 12 sessions with the approved level of therapist or shrink before HRT. It is interesting to me that the one I chose (astutely I hope) recommended me to an endo during in-take. To get Medicare (long story) to pay for 'therapy', requires a recommendation by a Doctor, so, rec. to endo for rec. back.... which when I thought about it, was stunning to me. What an opportunity, and I am confident the therapist knew just what she was doing. (I have not seen the endo, I am going through changes at a surprising rate without HRT, and figure to allow this to happen as it is, and when I go to this endo, she will be hard-pressed to deny I need help.)
The complexities of my relationship with the person I live in the house with are very indicative of the problems a woman faces, IN REAL LIFE (see my post in PMS Zone for EG). Now, maybe I should get a gig as a waitress to boot? Sure, maybe so, for my own enlightenment, what is faced by an average woman. As a test, before a Professional? Often as not, someone from an Ivory Tower background with preconceived, prescribed slots my life has always tended not to fit in the first place. Well, whatever part of this process I can subvert, I surely will.
In spite of my very slightly Libertarian positions, I will try to get the Federal Government to pay for as much of this (EG: HRT eventually) as is possible. This will almost certainly mean my compliance at some, at many stages.
ya do what ya gotta do I guess.

Ok after all this time I voted, not because I could honestly respond one way or the other, but my curoisity got the better of me and I wanted to see how the vote was going.

I voted yes, but I would have rather voted Not Sure.

Sarah

Love your post Jan.

Just a small point though...

Quote from: JanNow one of the hoops involves supposedly some 12 sessions with the approved level of therapist or shrink before HRT.

No where in the SOC does it state a requirement for the number of therapy sessions.  If you are being told that you will need "X" number of sessions for HRT to be prescribed they you are being milked for sure.

From the SOC:

QuotePsychotherapy is Not an Absolute Requirement for Triadic Therapy.
Not every adult gender patient requires psychotherapy in order to proceed with hormone therapy, the real-life experience, hormones, or surgery. Individual programs vary to the extent that they perceive a need for psychotherapy. When the mental health professional's initial assessment leads to a
recommendation for psychotherapy, the clinician should specify the goals of treatment, and estimate its frequency and duration. There is no required minimum number of psychotherapy sessions prior to hormone therapy, the real-life experience, or surgery, for three reasons:

1) patients differ widely in their abilities to attain similar goals in a specified time;
2) a minimum number of sessions tends to be construed as a hurdle, which discourages the genuine opportunity for personal growth;
3) the mental health professional can be an important support to the patient throughout all phases of gender transition. Individual programs may set eligibility criteria to some minimum number of sessions or months of psychotherapy.

The mental health professional who conducts the initial evaluation need not be the psychotherapist. If members of a gender team do not do psychotherapy, the psychotherapist should be informed that a letter describing the patient's therapy might be requested so the patient can proceed with the next phase of treatment.

Check out this here:  Psychotherapy for adults (http://susans.org/wiki/SOC#Psychotherapy_with_Adults)

Steph

that is interesting, Steph, considering the therapist that suggested this to me gave me the rec to the endo at intake, which she had not (will not) been paid for, a freebie (and when she will for actual sessions, will be underpaid, by Medicare, and told me 'don't worry about it we'll work something out', which boyo here (you know the one u said I oughtta pointy-toe his ass), the MFT, says I can take at her word.

Now that I look at the link more closely, thank you for that, my best guess is what she said was a test to gauge my commitment to this (she KNOWS there's no $$$ here, in fact seemed to be willing to take me on as a special case. Got Milk? (well maybe I do) Can you say 'blood from a stone'?), having noted my, ahem, independent tendency and persuasive bent came up with the endo rec as a fast track. Speaking of fast track, the MFT I live with qualifies as a "mental health professional" as of last Friday. hmmm.

Interesting question--

I think there needs to be some sort of safeguard, but does it have to be the Real Life Test, exactly as written and adhered to to-the-letter?  I think that too-strict an enforcement of the RLT can turn it into a ritual whose meaning and purpose become lost, and can also be used by misguided gatekeepers to deny as many people as possible the object of thir desire/need.

It's a little like how various groups view the criteria for dispensing welfare/social aid.  That there are people who need the assistance of welfare or some other form of institutional charity is acknowledged by most.  But there are various views on how criteria for reciving aid should be judged. 

At one end are the people who believe that no aid should be given except in the most extreme cases.  After all, if you coddle people by giving them handouts, they will have no motivation to work hard, and will become lazy.  Therefore, you make it as difficult as possible to get aid, so they will have to jump through many hoops to get it.  This will prevent those inclined to laziness and sloth from taking advantage of the system, etc., etc., etc.

At the other end of the system are those that believe that, although there may be those who wrongly take advantage of the system, it's better to allow this to happen rather than to inadvertanty prevent someone who really needs the aid from receiving it and possibly being driven to do something worse to alleviate their situation (such as stealing, or entering an abusive relationship that at least may provide living support, or,ultimately, killing onesself in order to escape the situation.)

My feeling is that a too-strict, ritualized, one-size-fits-all RLT can be as bad as having NO safeguards whatsoever.

But there needs to be something in there -- a checklist or an evaluation or something.

Also, what does it take to satisfy 'living in the gender role"?  Jeans or slacks, nice t-shirts or polo shirts, tenny-runner shoes and little or no jewlery is the de-rigeur 'uniform' for women where I work, with skirts/dresses a rarity.  Do I get penalized on my RLT if I wear less than a pantsuit to work?  And what happens if I'm not ma'amed enough?  I'm being a little rediculous here, but I really have no clue as to where the boundaries are.  And, the devil is in the details.

In a semi-perfect world, I'd have already come out as Karen, without fear that any negative fallout might affect my financial ability to transition (in a perfect world, I'd have been born as Karen...)  However, at work they are implementing a new personnel system that 'allows managers much more flexibility in managing personnel'.  Read between the lines, they're removing the safeguards from managers making capricious, arbitrary, and unchallengeable decisions (I'm already looking for escape hatches...)  And, correct me if I'm wrong about this, but it seems that society in general is a little more accepting of a TS girl if she's post-op than if she's pre-op, all other things being equal.

Finally, I think that starting RLT too soon can do more harm than good.  Didn't a girl used to have to complete a year of RLT before starting HRT?  In fact, RLT becomes easier as HRT feminization progresses.  Thus it seems that RLT before HRT is putting the cart before the horse.

What's the answer?  I think there needs to be some sort of validation process -- a checklist, as it were -- but I don't think that RLT (as I understand it) should be the only route to the summit.

And If you feel I have a wrong impression of what RLT must entail, PLEASE correct me.  I'd rather be 'wrong' and smarter because I've been corrected than 'right' and willfully ignorant.

Karen

Needless Obsticle

I don't see how SRS or the lack thereof is somehow going to make the RLT any easier. Face it, if you have lived as your birth gender all your life, when you start living as the other gender, what's in your pants isn't going to make ANY difference unless you plan to come out in a nudist colony or spend a LOT of time in public showers. If you can't make it past that point, I can see why they wouldn't want to operate on you. Should RLT be required for HRT? Of course not but for surgery, I def think so. You can call the first year you live as a woman whatever your want but this first year pre or post op isn't going to be easy for anyone.

Reasonable safeguard

It gives one a chance to back out if discriminated against
It tests if you can take it as the world treats you(no discrimination) just discrimination because you will be paid 60 percent of what a man gets
It also tests if you really want to live as a woman before surgery

Isn't "Real Life" the goal anyway?? Why rush things, or force things for some "test"...when you're ready, and feel safe, it should be your choice to go "full time"....you should not be pressured into it.

Not to mention....what if I ended up being a total tom-boy who wore work boots and flannel shirts, and cut my hair short...I don't need some "professional" telling me that I don't fit their mold, and therefore have failed some test.

I AM a woman. I don't need to prove that to anyone. I live as ME, and therefore I live "as a woman". No one will or can tell me how I should live, or how I NEED to live in order to receive the health care I need.

So glad for informed consent.

I think a real-life test is very important (at least for the SRS because once you go down that road there's no going back - miss your balls and having errections, oh well, too late now), afterall once you head into it and know this is who you are, you're in it for the long haul. Not up for the test, well, then maybe you either just aren't ready yet (need to muster up more courage; I went through my whole teens keeping who I was hidden inside but once I was ready unleashed it all), or are there are other issues (perhaps you aren't transsexual but think you are, but merely enjoy feminine things, playing dress-up for pleasure but not really feeling like a woman inside).

My therapist told me I had to live full time as a woman for 1 year before she'd consider HRT. Okay! Very next day I was out full time and felt very liberated. But then I was already working my way up to that point for several years, a little this a little that. It was a necessary experience. Can't say it all came easy, living as a boy/guy for about 20 years of my life, I had some relearning to do, but for the other gender. Afterall, I was well past the point when behavior came naturally, everything 'male' was drilled into my head, so I had to school myself, train myself pretty much from scratch. I was essentially a little girl within the body of a man, so my early beginnings were very experimental, like I were role-playing and trying to behave like the woman that I would later become. Now, all these years later, it all comes pretty natural, aside from some flaws (remnants of manhood) I pass as a woman in looks (so long as the adam's apple don't give me away), behavior (I'm not super girly, just me), and speech (I still find myself constantly checking this though).

The one thing I don't agree on though is having to see a therapist for any of this, but that's just me, I knew what I wanted, I knew who I was inside. What came of all that therapy (several years of it)? A lot of money down the drain which could have been used for SRS (would've been about halfway there to cover the cost). What'd we talk about? Not a whole hell of a lot really since I wasn't much of a talker, just how certain events of my week went, my home life, work, ect. The whole thing just pissed me off. But, I had to do it, either that or no hormones. I got what I wanted, she got paid, even exchange, I guess. I don't need some damn letter giving me permission, like I'm a child, to do something that has to be done. This is for my well being, not anyone else's, I have to live with it, and have for a long 15 years...I think its about time for that surgery. My mom keeps saying we need to play the lottery, I don't think I could ever get that lucky so don't bother.

The person I was in 2006 would not be friends with the person I am now. :laugh:

This question is probably a lot different for different people. As an ftm, I never saw a clear line between presenting as a woman and presenting as a man. Or maybe I personally felt a clear line, but nobody else did when they looked at me, so any external measures of whether I was living as my target gender would have been meaningless. There were major barriers to getting hormones, but how I looked and acted was never questioned. Everybody seemed to decide for themselves whether I was a "real" man (or whether I could become one), and a lot of people clearly had their opinions cemented before they met me.

I would likely have been damaged by a requirement to follow some kind of obvious-to-everyone-but-me script about gender before being allowed to medically transition. On the face of it that just looks like cruelty imposed by an in-group on an out-group.

I think it should merely be a suggestion before SRS.  It's your body, and you should be able to modify it anyway you like.  I personally went full time because I wanted to, not because it was required of me.  I probably will not get the whole shebang installed until I will have been full time for over two years and know damned well what I am getting into.

At least I already have my letter in hand for when I need it.