Susan's Place Transgender Resources

Ugh, how many people should there really be in the way of us just being who we are?

There's the SRS surgeon who demands the SOC be followed, which requires being full time for at least 12 months, a letter from the endo prescribing HRT, which requires a letter of recommendation from a therapist, which requires at least 3 months of therapy before handing out. Then, for some reason they require a second letter of recommendation from a different therapist, in a different field of therapy. Then there's just getting to the surgeon, which requires a passport, which requires me to update the name on the passport to match my ID, which requires me to update my birth certificate, which requires me to go to court to change my name legally, which requires me to list the name change decree in a newspaper for 4 weeks and wait...

...all of which costs thousands of dollars in total. Darn, I wish it could be as easy to get SRS as is was to get FFS. For FFS all I needed was money, there was nobody standing in my way, and no stupid rules to follow.

It's bitter-sweet, I have managed to find the means to get SRS done by March, but before I can make the appointment he requires 3 letters of recommendation, 2 from therapists and 1 from the endo who is prescribing HRT (never heard of this stupid rule before!). My therapist has said she will write the letter, but needs me to first get back with an endo so she can reference the endo in the letter. So now I have to wait until December 1st until they have an opening, which means I won't be able to get the letters for probably at least another month! The longer it takes to get the letters, the later I'll have to make the surgery appointment.

It sucks when everything is ready to go, I have confirmation from the therapist that I can get the letters, I have the down payment, but I have to continue to wait for this and that to fulfill the demands set by people who have no clue how hard it is to continue waiting after doing so for far too long already!

I want to scream.


AHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!


...ok, I feel a bit better now, but it's still ridiculous what we have to go through.


~Sarah

I feel you. I byassed the little ones when neccissarry(I don't really like consonents this much, but got redenned for ignoring them in the past). Srs solves(many, or most) legal issues point blank. I suspect soc as a buffer against malpractice at it's most innocent. If I have the $ together, I can get through the gates. I don't need to bs a bs'r.You have to know what people want to hear before trying to tell them what they want to hear. Would you turn out the lights & take take a plugged in toaster apart in the dark & go pokein' around in there with a butter knife? Dr's=no problemo, $=I am so screwed!

It'd be nice to have gatekeepers in ANY of this world that weren't as equally stupid as the person passing through it...

*hugz*
I hear 'ya (and this from after I got a hrt letter not to long ago, which is amusing for the fact that the clinic I go to rx'ed me meds without a letter making me wonder what the point was, but I digress)

In an ideal world, grs would be treated like any other surgery of non emergency nature where the patient would get a quick test that they have their head screwed on right, have realistic expectations about the outcome, and understand the potential complications. (and of course ability to pay or have it covered by insurance)

Unfortunately, in the world I'm stuck in, there are those who aren't sure of their identity or otherwise aren't looking at genital surgery for the right reasons. (either by confusing gender role and/or expression with identity, or a mental health issue causing delusional thinking)

While I get the need for making sure that people who want genital surgery are sure of identity, and psychologically ready, making the process of surgery and social integration shouldn't have to be an endurance race or a litmus test of being ->-bleeped-<- enough (or at least able to bs it) to get the letters.

While there are those who will get surgery who shouldn't, the current 2 letters system does nothing to address those unable to go through the so called proper channels all the way through transition. There is alot of DIY hormone use out there, and people with no access to either a qualified therapist/psychologist/psychiatrist, or one they can't afford to see regularly.

My *ideal* (requirements for hrt and surgery) would be simply 1 letter of recommendation from a qualified therapist/psychologist/psychiatrist (no rubber stampers) based upon 3 months of sessions to obtain medical services. The rest would be informed consent based on the stable mental health of the patient.

I can only dream until then, and in the mean time do what I can to inform others of the process so they too can do their own version of informed consent.

I'm sure you know, Sarah, that this process is laid out in this way for several legitimate reasons.  The gatekeepers of course want some legal protection against suits but probably each of them wants to feel like they are doing the right thing. 

Since SRS is irreversible, everyone involved wants to be sure this is the right thing to do.  How do they know that, if the only way they can find out is for you to tell them?  Well, of course you can tell them anything, hence the problem.

Another element in this, of course, is that changing from one social gender to another is very complex and your body parts are only one small piece of a much larger puzzle.

Changing my name and IDs was pain-free.  It cost money and was a hassle, but otherwise no big deal.  But the medical steps need some assurance this isn't something you just woke up one morning feeling a little off and decided would be fun.

(In the begining I told several people that at first I couldn't decide whether to clean my garage or become a woman, but had finally decided to become a woman.  They all saw the silliness of this.)

But of course you know all this Sarah, don't you?  You just want to complain.  Bitch away, girl.  And good luck with your journey to wholeness. :icon_flower:

- Kate

Quote from: K8 on November 11, 2009, 09:32:39 PM
Changing my name and IDs was pain-free.  It cost money and was a hassle, but otherwise no big deal.  But the medical steps need some assurance this isn't something you just woke up one morning feeling a little off and decided would be fun.

You know, I've heard that argument quite a few times, my doctor even brought it up. But I've been wondering. Has that EVER actually happened?

I know people with other psychological issues have mistakenly undergone transition only to end up with genuine gender dysphoria as a result. But has anyone, anywhere, ever transitioned purely because they thought it would be something interesting to try? I just can't see any mentally competent person, male or female, ever thinking that. And if they're mentally incompetent, then what you're really doing is keeping mentally incompetent people from access to life altering surgery, so why isn't that the example?

I know comments of "we need to protect people who might just decide "i wonder what it's like being the opposite sex"" are for the most part not serious suggestions that are meant to be taken literally. But I've always found it a rather odd way to make the point. Has it EVER actually happened?

I just find it strange because I can't see anyone, for any reason, perusing transition on a whim. Mentally competent or not. But all too often medical professionals seem to seriously propose that they need to protect such people.

Personally, I'm pretty individualist, I don't believe in the massive bureaucracy "protecting people from themselves". I think all it does is function marginally if at all at actually protecting vulnerable people, but all too often hinders people who know what they're doing.

I for one often feel like screaming out to medical professionals "please for the love of god stop trying to save me!"

It doesn't help that I've had a run of bad doctors who feel the need to treat me as a personification of GID rather than an actual person who might in fact already have an educated and informed view of what she wants.

There have actually been cases where people after GRS regret their decision, and a couple have even tried detransition after surgery...I remember hearing about this one MtF that hastily had surgery, decided after the fact he was a he after all, and spent a lot of money more trying to correct the damage he had done to his own body. Then went all gung-ho to the press about how horrible and deluded real transsexuals were and that this shouldn't be a legal procedure.

So in a way, I'm glad that some of the hoops are in place...the RLT/HRT time especially. Because some people might not pass in a way that will allow them to carry on as normal bio-men/women would, and should see the public feedback they will get before the big jump and they get stuck in a situation that is not what they had planned for. And as Kate said, helps weed out the nutters that just jumped out of bed, spun the roulette wheel and said "oh, looks like I should become a woman today".

That said, I wish there were easier treatments and routes available for those that can't afford to keep up therapy + HRT + regular docs visits, etc etc etc.

you would think that the sheer cost of transitioning would prevent people from doing it on a whim really i mean who blows 60000 or more just to expierment so it would seem the rules are to prevent the insane from harming themselfs and legitamate GID people are caught in the web as well
jessica

Quote from: jesse on November 12, 2009, 03:45:44 AM
you would think that the sheer cost of transitioning would prevent people from doing it on a whim really i mean who blows 60000 or more just to expierment so it would seem the rules are to prevent the insane from harming themselfs and legitamate GID people are caught in the web as well

But insane people do get referrals. It just slows everyone down and hands money to the medical profession.

*** loves living in Ontario Canada :D

Quote from: SaraR on November 12, 2009, 07:03:48 AM
*** loves living in Ontario Canada :D

wonder if i can become a canadian lol

I think if I was a surgeon, I would want some assurance that I was doing what was needed before performing irreversible surgery that would alter every aspect of someone's life forever.  Since, as a surgeon, I would not be qualified to determine the emotional and psychological needs of the patient, I would want someone else to evaluate the patient for me and give me the go-ahead.

As a patient, I want to make very sure that a) this is what I want, and b) I will be able to live my life successfully in this very different social role before taking a step that will change my life forever and from which I will not be able to return.

- Kate

Don't kid yourself, gatekeeping never ends.
There's always another hoop to jump through.

:(

quite frankly i think and this might sound anti social or crazy that if you go into this on a whim or w/o a care about the results then you get what you deserve
i have yet to meet a transperson who wasnt well educated on whats going on what the effects of hrt is what reasonable expectations can be achieved any loss suit generated by someone who says he shouldnt have been given srs or grs or even ffs because he wasnt really aflicted with gid should be thrown out of court. Just saving the amount of money required for the procedures indicates competant decision and goal setting thinking so im sorry i have to advocate personal responcibility i think they should reduce requirements to a signature on an informed consent form and be done with I.E. you are aware that this surgery is irriversable : answer yes okies you get what you ask for...end of story this is just anouther way for the american society to protect the stupid from themselfs ie dont drink on a bottle of draino ......really you think ...
jessica

I've got two observations about this. First of all, I have learned that our beloved American legal system is set up to preserve billable hours and fees charged by their fellow lawyers to us stuck in the system. Here in the states, it is difficult to do anything and get a fair trial in front of a judge who is also a lawyer. The analogy extends to SRS and our psychology profession. We have to be in therapy for x number of months to get our HRT letter, which another doctor will charge me for an evaluation as to my health to take meds. During my RLE, I'm still seeing my shrink and checking in from time to time to let him or her know about things. (at over $100/hr) I want my SRS letter, so I'm going to play by the rules. I then have to pay again for my first SRS letter, then schedule time with a second psychiatrist for more evaluation and a letter request costing me hundreds more.

There is a cottage industry involving the care of people with GID that is necessitated by the fact the our medical condition is still listed in the DSM. If you look into the history of us getting put there, it was after the likes of kooks like Dr. Paul McHugh who called us psychotic. He was one of the people who shut down the John's Hopkins hospital program for TG patients. He was also a religious zealot with an agenda. Once these programs shut down, we went to the 'pay for play' gender transition business run by the psychologists and surgeons just looking to cover their butt. I'm not saying that the old gender clinic era was the best, since only 15% of applicants got approved for surgery based on ridiculous standards.

It is amazing to me that I can walk into a plastic surgeon's office and get complete FFS or Breast augmentation without a letter. These are much more visible signs of feminization to the public at large, and in the case of FFS, equally permanent.  Again, I blame this on GID being included in the DSM manual as a psychiatric disorder. I don't think that there should be the gatekeeper function to the degree there is today. For many individuals, the costs are prohibitively expensive and puts GRS out of the reach of too many people. 

Maybe I'm stupid.  I am old and still tend to be naïve.  I was in the military for a long time and am used to taking sensible orders and refusing insensible ones.  I follow direction well.  (I had a lover say that to me, but it sounded like a good thing at the time. ;))

I see the gatekeeping as helpful to me as I struggle through this.  This is not like buying a car or picking up a puppy at the shelter.  This is my life.  I want help along the way.  I want some validation that this is, indeed, something I should be doing.

I've done a lot of crazy things in my life.  There were a few times it would have been helpful to check with someone before I did them.  GRS is a BIG deal.

But each of us is different.  And part of the gatekeeping is a carry-over from days when transition was less socially acceptable and assimilation much more difficult.

For me, I cherish this year between starting RLE and my surgery.  I don't expect to do this again.  I'm having the time of my life.  I will be glad and eager to get the surgery, but I want to savor every moment of the work and anticipation to get there.

But, as always, YMMV.

- Kate

Well, while it can be annoying I think that it makes sense to have the SOC and therapists in place. It wouldn't be very smart to rubber stamp any and all people that come in requesting HRT and surgery. Even though there a lot of people that are 100% sure of what they want there is always going to a few that have no idea about what they really want (i.e. someone that would transition from MtF and then transition back to where they were before). It's just a fact of life that there are going to be some hoops to jump through in this process and that's just the way that it has to be.

Quote from: asfsd4214 on November 11, 2009, 11:02:32 PM
You know, I've heard that argument quite a few times, my doctor even brought it up. But I've been wondering. Has that EVER actually happened?

Well, I found this page (http://ai.eecs.umich.edu/people/conway/TS/Warning.html) early on. *shrug*

Quote from: juliekins on November 12, 2009, 09:23:20 AM
There is a cottage industry involving the care of people with GID that is necessitated by the fact the our medical condition is still listed in the DSM. If you look into the history of us getting put there, it was after the likes of kooks like Dr. Paul McHugh who called us psychotic. He was one of the people who shut down the John's Hopkins hospital program for TG patients. He was also a religious zealot with an agenda. Once these programs shut down, we went to the 'pay for play' gender transition business run by the psychologists and surgeons just looking to cover their butt. I'm not saying that the old gender clinic era was the best, since only 15% of applicants got approved for surgery based on ridiculous standards.

Just a little off-subject here, but I thought the university-based clinics shut down because they were there to do research and at some point stopped being helpful to their patients.  That was my experience with Johns Hopkins.  I'll have to read about Dr. McHugh.

When I went to JH in '96, they couldn't figure out why I was there.  I had a good job and a stable marriage.  I wasn't on drugs or abusing alcohol.  I wasn't in jail or suicidal.  What was my problem?  I was just a normal person with GID.  They weren't interested.

They did a lot of useful work in the beginning, but my impression was that they outlived their usefulness.

And now, back to our regularly scheduled thread...

- Kate

Quote from: K8 on November 11, 2009, 09:32:39 PM
(In the begining I told several people that at first I couldn't decide whether to clean my garage or become a woman, but had finally decided to become a woman.  They all saw the silliness of this.)

- Kate

{hijack}
I was told that my transition was a stupid excuse to get out of a marriage.  It seemed rather harsh...   :D ;D ;)
{/hijack}

-Sandy

There is a growing number of health care professionals who are following a relaxed set of standards for this now. In my area in California, the requirements for getting a letter are not fixed. One can get on HRT in a matter of a month or so and not need to see an endo. We have a GP who does it. She spoke to a TS support group last year that many across the US are now doing a more patient specific scheme.  Some are clearly ready sooner and get their letters fast others who are less so will be required to wait. We have many trans people in our area. My therapist estimated 20000 in the tri-county area. I also went to four gender therapists all saw me on a sliding scale or were free paid by the state.

I got had my SRS letter three months after I started seeing my therapist and after three months of full time. Now, it is also true that I was on DIY HRT for seven years and was dressing in androgynous clothes for over a year before and my hair was shoulder blade length so going full time was not much of a stretch. Basically, it was getting a nice women's hair style and carrying a purse. It ended up that I got my SRS letter about the same time as my legal name change.

So things are changing and for the better.

Maggie

My issue with the "Gatekeeper" concept is because we are diagnosed with GID as psychiatric issue with no recommended treatment option listed for this diagnosis in the DSM, we are at the whim of which ever therapist we happen to stumble upon. Hopefully one gets hold of a good one, one familiar with the SOC and the subsequent recommended treatment options that are advised there. Sadly there is nothing in the DSM that tells a Dr. of Psych or any other therapist that this is the "way it works". And it is this that I feel is the primary reason why we are in "limbo" as to correct diagnosis and treatments accompanied by coverage availability through insurance health plans.

I think the "idea" of being seen by a Therapist when dealing with the results of gender issues are wise. This helps one to understand that they actually are not crazy for "believing" themselves to be the opposite gender in which they were pronounced at birth. The only activities a therapist should have in the issue of GID is to make certain the depression that results from years of holding, in private, these thoughts of opposite gender are dealt with to remove the self-harm danger that lurks there. Also, to help them find a way to adjust and cope if transition is the individuals path to be taken.

I'd like to see the system changed to reflect a GID diagnosis in the DSM as a medically necessary condition. So that once the depression is dealt with "successfully", the entire emphasis is then placed in a qualified medical setting to treat the actual medical condition. That way, I think the process would be greatly less complicated and we wouldn't feel as though we are on a merry-go-round where no one will stop the ride to let us off!

The physicians would still be covered for malpractice. It could reduce the overall time frame for making the life altering adjustments. And, we then, could get on with our lives and ultimately be more productive in them!

Sadly though, as Juliekins pointed out, the current system is more about "money" than it is about fixing the problem at hand.


Dawn   

Quote from: Dawn D. on November 12, 2009, 11:56:30 AM
... because we are diagnosed with GID as psychiatric issue with no recommended treatment option listed for this diagnosis in the DSM...

Hate to break the news, but the DSM (Diagnostic and Statistical Manual of Mental Disorders) doesn't have recommended treatment options for anything.

Quote from: Dawn D. on November 12, 2009, 11:56:30 AM
Sadly though, as Juliekins pointed out, the current system is more about "money" than it is about fixing the problem at hand.

Ain't that the truth  :'(

Quote from: jesse on November 12, 2009, 07:45:45 AM
i have yet to meet a transperson who wasnt well educated on whats going on what the effects of hrt is

Then you're lucky. I go to meetings and hear guys say crap like, "I'm starting T next week! What should I expect? When will my voice drop? Will I get acne? Will I get facial hair? Will it start to fall out if I stop taking T after being on it for a while?"

And I'm sitting there, rolling my eyes and thinking, "Homicide really IS the only option."

Quote from: Flan on November 12, 2009, 12:03:07 PM
Hate to break the news, but the DSM (Diagnostic and Statistical Manual of Mental Disorders) doesn't have recommended treatment options for anything.

Yes Flan, I'm aware there are not treatment options for "anything" in the DSM. Which is why I feel this argument should give greater weight to the concept of necessitating a referral to a "qualified medical setting" for the "actual medical condition" since it has been described as such by AMA Res. No. 122, once you've been diagnosed with GID.

Let the Psych. Dr.'s deal with the resultant trauma creating a depressive state of mind, not caused by GID, but by, having to deal with a lifelong state of misunderstanding who and what we are.


Dawn

Quote from: Renate on November 12, 2009, 07:26:38 AM
Don't kid yourself, gatekeeping never ends.
There's always another hoop to jump through.

:(

A world which is an ouroboros of endless and infinite fellatio?

It's not the hoops I mind, it's the cost of the hoops...

Quote from: K8 on November 12, 2009, 09:25:42 AM
I see the gatekeeping as helpful to me as I struggle through this.  This is not like buying a car or picking up a puppy at the shelter.  This is my life.  I want help along the way.  I want some validation that this is, indeed, something I should be doing.

No one is wanting to take away your possibility of seeing a therapist if you want to. Other people just don't want to be forced into it.

I chose to opt out of the therapest option. I went to one session, got my "ya she's ready hrt permission slip(for just in case)", & the thing sits burried at the bottem of some drawer unused/needed(did my homework before chosing my MD). I'm curious as to has/is anyone getting strung along by a therapest?

Quote from: Bellaon7 on November 12, 2009, 05:47:42 PM
I chose to opt out of the therapest option. I went to one session, got my "ya she's ready hrt permission slip(for just in case)", & the thing sits burried at the bottem of some drawer unused/needed(did my homework before chosing my MD). I'm curious as to has/is anyone getting strung along by a therapest?

I was going to be, which is why in a week or so I see my third therapist.

My first two made it clear they wouldn't recommend me for HRT until I had dressed like a female and proven that I was acting like one 24/7. Which since I can't prove that even if I wanted to because I don't know anyone because of my isolation because of my gender issues over the past year. And because it's a completely arbitrary waste of time. I simply stopped going to both of them after a couple sessions.

I'm only going to the third to try and convince them to write a recommendation. I have no idea what I'm going to talk to them about for the minimum 3 months I'm told they will take before recommending me because I've already gone over everything in my life literally hundreds and hundreds of times over and I don't see myself gaining any insight I haven't already gained. (Certainly neither of the first 2 therapists or my own doctor offered any when they asked a question invariably starting with "have you considered ...").

So yeah, I'm pretty fed up with gatekeeper mentality, and I've probably become very biased against therapists thanks to my experiences with them.

Quote from: jesse on November 12, 2009, 07:05:36 AM
wonder if i can become a canadian lol

sure come on over

Would it be in any way conceivably possible to post an ongoing list of useless therapests by name to save as many of us as possible from this truely horrifying fate?

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Post Merge: November 12, 2009, 07:56:47 PM

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wouldnt that be nice bella check a list before wasting hundreds of dollars
jessica

How many gatekepers? none! it's the worst kind of behaviour with people controling our lives is not a help. The U.K NHS system are the worst culprits. But I always thought the U.S was more liberal and had less of a 'gatekeeper' mentality?

Quote from: SaraR on November 12, 2009, 07:03:48 AM
*** loves living in Ontario Canada :D

I do as well, but had a really hard time finding resources. It seems like it's hard to find information if you are not in a big city.

Quote from: jesse on November 13, 2009, 02:53:31 AM
wouldnt that be nice bella check a list before wasting hundreds of dollars
jessica

Absolutely. I have run into many psychiatrists who have insulted me and haven't been willing to help.

I'm glad I didn't resort to going to CAMH, the woman who helped me setup an appointment with a good GID psychiatrist said that she deals with people who are emotionally damaged from their experiences there. They would have made me jump through even more unnecessary hoops as well.

Quote from: Tristan H. on November 14, 2009, 09:34:40 AM
I do as well, but had a really hard time finding resources. It seems like it's hard to find information if you are not in a big city.
Absolutely. I have run into many psychiatrists who have insulted me and haven't been willing to help.

I'm glad I didn't resort to going to CAMH, the woman who helped me setup an appointment with a good GID psychiatrist said that she deals with people who are emotionally damaged from their experiences there. They would have made me jump through even more unnecessary hoops as well.

From your post Tristan It starting to sound so familiar with the abusive nature of U.K system. I always thought the U.S were much better towards this kind of treatment.

Quote from: Naturally Blonde on November 14, 2009, 09:42:41 AM
From your post Tristan It starting to sound so familiar with the abusive nature of U.K system. I always thought the U.S were much better towards this kind of treatment.

Well I'm from Canada and it varies from Province to Province. Some don't even have free healthcare, as it's not national system.

We are covered for therapy if it's a psychiatrist, and with those it's hit or miss. We aren't covered for hormones or surgery unless it's through CAMH, which has a bad history with the TG community here. I'm hoping that the community here gets fed up enough to make enough complaints so that the government re-evaluates what clinics should be covered by OHIP(Ontario health insurance) in terms of surgery and hormones.

Quote from: Tristan H. on November 14, 2009, 10:03:04 AM
Well I'm from Canada and it varies from Province to Province. Some don't even have free healthcare, as it's not national system.

We are covered for therapy if it's a psychiatrist, and with those it's hit or miss. We aren't covered for hormones or surgery unless it's through CAMH, which has a bad history with the TG community here. I'm hoping that the community here gets fed up enough to make enough complaints so that the government re-evaluates what clinics should be covered by OHIP(Ontario health insurance) in terms of surgery and hormones.

We don't really get free healthcare either. Our condition is loathed by the NHS and they will try their best not to help us. They also have psychiatrists who are only trained in psychiatry (usually males) and not trained in gender issue's or medical matters or how to go about helping TG patients.
I was personally refused HRT by the NHS psyciatrists and had to go private in order to start hormone therapy. Six years down the line the same thing happened again when I tried to get NHS referrals for SRS. Unfortunitely the NHS see it as a lifestyle 'role change' and not a physical 'gender change' which is what I was seeking.

In the end I had to create my own treatment program independently and got referrals quite easily. If you are serious about transition and want to go about it properly and need various surgical proceedure's the NHS is best avoided. I'm starting to think other countries like Canada's health system are also a problem for people suffering with GD.

Well, you have to understand that Canada's healthcare system isn't nation wide, it varies. Some provinces cover TG issues and some don't and it all depends on how. Ontario is one that covers it, however only it's only covered entirely through CAMH. CAMH does have people specialized in GID and gender issues, but they are very backwards thinking. Since all psychiatrists are covered by OHIP, we can easily find coverage for the therapy elsewhere, we just have to find the right psychiatrist which means we don't have to go to private practise necessarily. My issue was that I live in a very small town and found myself being denied by clinics in Toronto for being too far, I eventually did find a group close to me that could refer me to a good psychiatrist that is helpful for GID. I also found out that the original psychiatrists(who weren't specialized in GID) that I went to, were getting complaints from other patients. My town isn't known for being the best medically.

Ontario's system would be much better if we would expand the coverage to more clinics. I cannot speak for other Provinces, though, as I don't know how their systems work.

Quote from: Tristan H. on November 14, 2009, 10:25:58 AM
Well, you have to understand that Canada's healthcare system isn't nation wide, it varies. Some provinces cover TG issues and some don't and it all depends on how. Ontario is one that covers it, however only it's only covered entirely through CAMH. CAMH does have people specialized in GID and gender issues, but they are very backwards thinking. Since all psychiatrists are covered by OHIP, we can easily find coverage for the therapy elsewhere, we just have to find the right psychiatrist which means we don't have to go to private practise necessarily. My issue was that I live in a very small town and found myself being denied by clinics in Toronto for being too far, I eventually did find a group close to me that could refer me to a good psychiatrist that is helpful for GID. I also found out that the original psychiatrists(who weren't specialized in GID) that I went to, were getting complaints from other patients. My town isn't known for being the best medically.

Ontario's system would be much better if we would expand the coverage to more clinics. I cannot speak for other Provinces, though, as I don't know how their systems work.

It sounds very similar to the U.K. We have about 4 gender clinics in the whole country and for me they are of no benefit whatsoever. I wanted a complete physical change which is not covered or endorsed by NHS gender clinics. The only endorse 'role changes' without surgery.

The private sector is much better but patchy and it's not always easy to find the right people for the type of surgery you may need.

Thank goodness that this is all behind me! I was able to do it privately, with my own out of pocket money since my insurance would pay nothing. It nearly broke me, but I'm now where I need to be as a woman.

I know two friends whose therapist seem to be using the carrot and stick approach. The therapists are hanging out the hope of getting the HRT letter, but are making them overcome their other personal issues first. In the one case, a friend started smoking again due to the stress of coming out and possibly losing her wife. The therapist wanted her cured of some other childhood stressors first, as well. She can't get her letter until she stops smoking. In the case of my other friend, she has a lifelong eating disorder. Her therapist won't allow the HRT until she overrcomes a 40 year battle.

I understand that stopping self destructive behaviors like smoking, drinking or abusing food are healthy changes. But I have a problem with some of these therapists trating us like children in the process. Did it occur to them that the REASON we do these things is that we are living our lives in the wrong body and gender? Sometimes I get the feeling like it is simply a matter of getting more sessions in at $100+ per hr. or even may be some type of control or power trip. Thoughts? 

Quote from: juliekins on November 15, 2009, 12:38:09 PM
Thoughts?

That's one of my gripes about the lack of consistency in taking into account the individual needs of the client, instead of saying "what can (we) do to make you a more happy and healthy person" there is an attitude in some circles of "only if you do x and y, I'll allow z".

While in some ways that can be good if intentionally (trying to) stop something from happening will prevent health side effects, saying "no" for the sake of going by the book is a good way to make desperation and defiance. (in a "they won't stop me when the grey market is on my side" sort of way)

just my 2 cents not counting inflation

Quote from: juliekins on November 15, 2009, 12:38:09 PM
Thank goodness that this is all behind me! I was able to do it privately, with my own out of pocket money since my insurance would pay nothing. It nearly broke me, but I'm now where I need to be as a woman.

I know two friends whose therapist seem to be using the carrot and stick approach. The therapists are hanging out the hope of getting the HRT letter, but are making them overcome their other personal issues first. In the one case, a friend started smoking again due to the stress of coming out and possibly losing her wife. The therapist wanted her cured of some other childhood stressors first, as well. She can't get her letter until she stops smoking. In the case of my other friend, she has a lifelong eating disorder. Her therapist won't allow the HRT until she overrcomes a 40 year battle.

I understand that stopping self destructive behaviors like smoking, drinking or abusing food are healthy changes. But I have a problem with some of these therapists trating us like children in the process. Did it occur to them that the REASON we do these things is that we are living our lives in the wrong body and gender? Sometimes I get the feeling like it is simply a matter of getting more sessions in at $100+ per hr. or even may be some type of control or power trip. Thoughts?

I think, and have thought for a while now, that the medical profession attracts the same sort of people as the education profession, which is to say they attract a type of person who feels a need to have a small corner of the world where they can play god in.

Quote from: juliekins on November 15, 2009, 12:38:09 PM
Thank goodness that this is all behind me! I was able to do it privately, with my own out of pocket money since my insurance would pay nothing. It nearly broke me, but I'm now where I need to be as a woman.

I know two friends whose therapist seem to be using the carrot and stick approach. The therapists are hanging out the hope of getting the HRT letter, but are making them overcome their other personal issues first. In the one case, a friend started smoking again due to the stress of coming out and possibly losing her wife. The therapist wanted her cured of some other childhood stressors first, as well. She can't get her letter until she stops smoking. In the case of my other friend, she has a lifelong eating disorder. Her therapist won't allow the HRT until she overrcomes a 40 year battle.

I understand that stopping self destructive behaviors like smoking, drinking or abusing food are healthy changes. But I have a problem with some of these therapists trating us like children in the process. Did it occur to them that the REASON we do these things is that we are living our lives in the wrong body and gender? Sometimes I get the feeling like it is simply a matter of getting more sessions in at $100+ per hr. or even may be some type of control or power trip. Thoughts?

The U.K's NHS GIC's also play it with a carrot and stick mentality. I had no underlying problems and according to previous psychistrists had no mental health issues whatsoever. I have never taken drugs, never smoked and I don't drink alchohol. But the NHS still refused HRT but it was very easy for me to get HRT privately.

At least in the States those gatekeepers have nothing to do with protecting the patient, but everything to do with protecting the doctors and hospitals from lawsuits.

Quote from: tekla on November 16, 2009, 09:33:27 AM
At least in the States those gatekeepers have nothing to do with protecting the patient, but everything to do with protecting the doctors and hospitals from lawsuits.

In the U.K they only protect themselves and not the patient. If the patient gets so despressed from the refusal of treatment they attempt suicide, the psychiatrists couldn't care less.

But when he said it, he looked into my eyes like he really meant it.

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Post Merge: November 18, 2009, 05:21:14 PM

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Quote from: Bellaon7 on November 18, 2009, 05:20:25 PM
But when he said it, he looked into my eyes like he really meant it.

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Post Merge: November 18, 2009, 05:21:14 PM

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Which relates to?

Again, more gatekeepers hell bent on making me jump through hoops!!! I just got a call back from the therapist who I was referred to for my second SRS letter today, and she starts saying how I'll need to see her 3-4 times before she'll write a letter!! If she's the same price as my last therapist, that's another $600...for a letter!!! Plus, that's another month and half or two more that I'll have to wait for the surgery!

It's so frustrating being so close to completion, and wanting to just get on with the rest of my life already, but constantly having to continue to shell out hundreds and thousands of dollars for needless "therapy" that I don't need or want. I thought I'd be able to have the surgery done by march or April, but noooooooooo, the therapist is going to make me wait even longer so she can make an extra few hundred or cover her ass for no reason.

I swear, these therapist's are going to drive me insane!!!

~Sarah

hmm next appointment ask her if you can just give her the 600 dollars sign an informed consent sheet and be done with her. lol when she looks at you crazy ask her if she really is looking at you do i even remotely look like a male to you do you think i want to be a male please lol of course shell then try to say you have anger repression issues or some other crap and delay you even more
such is the world of the insane
jessica

I feel for you Sarah. <<<hugs>>>

Wouldn't it be nice if someone could come up with a proper diagnostic test for this which didn't rely on perpetual delays and driving the genuine cases to the edge of suicide (and sometimes beyond it) just to weed out those on the wrong track.

It feels like they are punishing the innocent to weed out the guilty and it makes me mad every time I hear another example.

I know some may disagree but frankly I have thought, since my own treatment decades ago, that the Benjamin rules are barbaric outdated and frankly it's sign of just how poorly medically served we are that in all that time no one has come up with a better treatment and diagnosis protocol.

Come on medical researchers - where are you on this? It's been three decades since I went through and if anything things have got worse!

To the title question?
As many as it takes to get that lightbulb in there. Oh, and I suppose one more to actually guard the gate.
(Sorry, I couldn't help it...  ^_^)

Seriously though? Ideally, you'd only need one, to keep out the occasional crazies/idiots, and the others would all take their word for it that you're not either of these. But that would require this person to actually know what they're doing, and care about your welfare as opposed to getting paid, which both appear to be quite rare. Potential lawsuits don't help, either.

So many letters. Do they feel no guilt for the forests they're obliterating?..

Quote from: SarahR on December 10, 2009, 02:49:19 AM
Again, more gatekeepers hell bent on making me jump through hoops!!! I just got a call back from the therapist who I was referred to for my second SRS letter today, and she starts saying how I'll need to see her 3-4 times before she'll write a letter!! If she's the same price as my last therapist, that's another $600...for a letter!!! Plus, that's another month and half or two more that I'll have to wait for the surgery!

It took me nine years to get a SRS referral through the NHS and even then I had to get two referrals independantly. If you think it's hard in the U.S.A try living in the U.K

I believe that there are three kinds of therapists for second letters.

• Those who can do it in a single session, don't know you from  Eve (or Adam) and charge a lot of money.
• Those who can do it in a single session, can vouch for your first therapist personally and charge a medium price.
• Those who "want to get to know you" and require multiple sessions.

When presented with a full set of choices you need a computer spreadsheet to evaluate
all the costs (including travel) to determine which is the cheapest.

Quote from: rejennyrated on December 10, 2009, 03:12:17 AM
I feel for you Sarah. <<<hugs>>>

Wouldn't it be nice if someone could come up with a proper diagnostic test for this which didn't rely on perpetual delays and driving the genuine cases to the edge of suicide (and sometimes beyond it) just to weed out those on the wrong track.

It feels like they are punishing the innocent to weed out the guilty and it makes me mad every time I hear another example.

I know some may disagree but frankly I have thought, since my own treatment decades ago, that the Benjamin rules are barbaric outdated and frankly it's sign of just how poorly medically served we are that in all that time no one has come up with a better treatment and diagnosis protocol.

Come on medical researchers - where are you on this? It's been three decades since I went through and if anything things have got worse!

Research is being done, quite a bit of it, but the more is done the more it points toward GID being something other than what it has been popularly defined as for so many years.  This research points more and more toward GID being mental than medical.  Mental problems necessitate mental health solutions which may sometimes include medical intervention.  We are a long way off from this being termed exclusively a medical diagnosis (perhaps though because it rightfully isn't, but more research is needed).  Until then, because consensus cannot be reached, we will continue to need 'gatekeepers.'  The more honest trans people are generally with their therapists, communities, and most importantly themselves, the more likely better treatment processes will arrive, but so many of us feel the need to perpetuate a the image of a prototypical TS to the outside world (when it doesn't totally describe us), that it is no wonder the mental/medical community is suspicious.  My eyes about roll out of my head when I hear the standard trans story considering how many I've met in real life who have admitted otherwise to non-gatekeepers.  I cannot imagine how hard it must be for a gender therapist/psychologist who actually has to wade through all these standard stories and half-truths at the risk of lawsuit.

Quote from: interalia on December 10, 2009, 07:31:49 AM
This research points more and more toward GID being mental than medical. 

??? We must be reading different research papers then because the last three I have read all point to minute gene faults on certain chromasomes. One was pointing to an epigenetic effect and the other two were faults relating to the way that neural development was moderated by testosterone - in effect they were suggesting it was like a rather specialised variant of androgen insensitivity - which is a medical condition that I have anyway.

From memory one of the researche papers was from Prince Henry Instutute in Australia, one from a UK research group and I can't recall where the other was but I'm pretty sure it was Europe somewhere.

Admittedly the research I'm talking about was only published in 2008/2009 and probably hasn't been fully replicated yet - but I was under the impression, and I have read the actual papers not some news digest, that it was becomming pretty darned clear that in many cases it was indeed medical. I was certainly convinced by what I read anyway.

EDIT:

Just so you don't think I'm making that up I found this example:http://shb-info.org/id37.html (http://shb-info.org/id37.html)

It isn't any of the ones I was thinking about - but it is a similar result.

Quote from: SarahR on December 10, 2009, 02:49:19 AM
Again, more gatekeepers hell bent on making me jump through hoops!!! I just got a call back from the therapist who I was referred to for my second SRS letter today, and she starts saying how I'll need to see her 3-4 times before she'll write a letter!! If she's the same price as my last therapist, that's another $600...for a letter!!! Plus, that's another month and half or two more that I'll have to wait for the surgery!

Sarah, I don't know if you are anywhere near Chicago, but Dr. Randi Ettner, who is a psychiatrist, will see you for an hour and then send you an evaluation letter which should contain your "medical necessity and approved for GRS". If you can't find her phone #, then pm me, and I will see what I can find. I think your appt with her with letter will be in the $250 range. I know it's not what you want to hear, but it may work out for you. Maybe you can Skype or Yahoo video mail her, and do the appt that way?

minute gene faults on certain chromosomes

First of all, because its very important to stress - there are no 'faults' as such in the DNA/RNA assemblage.  In so far as we know, there are only mathematical variations that occur.  "Fault" implies some sort of values-based judgment, where the natural order provides no such assessment.  Nature has no good or bad only a probability of occurrence.

But, back to the quote:  I think in the end everything is going to come down to this, or living world (bacteria, viruses).  The DNA code, if not setting up exact specifications, at least pushes the odds in one way or the other.  In other words, DNA does not make one a TS, but certain DNA configurations make it more (less) likely that the person may well develop in that manner.

In that way, it may become much harder to point to a difference between mental and medical in the future.  It will be much more of a matter between DNA factors or and outside/invasive forces (injury, infection, flu).

I used to tease my Xian students there at the Super Huge State University of Science and Technology about their protests of Darwin being two major scientific advances behind other things that they would like even less.  Those being advanced physics, and DNA.  Now that advanced physics thing, forget about it, they couldn't read Darwin correctly (and Darwin wrote very well) I'm such not going to start handing out Einstein, Planck, and Heisenberg to them.  (Much less Chaos stuff)  But DNA, that's very interesting, because what happens if it turns out that so much of what we think is 'choice' and 'free will' (thereby a 'sin' or a 'not sin') turns out to be pretty much encoded into us? (By god itself, who else in their world view could possibility code DNA?, Matter of fact - currently painting themselves into a corner - the fundys here in the States use DNA as proof of "intelligent design'.) Hummm... 

So what happens when most of this turns out to be - not a birth defect - but a birth variation?  Then what happens when we find out how to control it? (Or at least gain the illusion of control over it).

Quote from: tekla on December 10, 2009, 11:29:10 AM
minute gene faults on certain chromosomes

First of all, because its very important to stress - there are no 'faults' as such in the DNA/RNA assemblage.  In so far as we know, there are only mathematical variations that occur.  "Fault" implies some sort of values-based judgment, where the natural order provides no such assessment.  Nature has no good or bad only a probability of occurrence.

But, back to the quote:  I think in the end everything is going to come down to this, or living world (bacteria, viruses).  The DNA code, if not setting up exact specifications, at least pushes the odds in one way or the other.  In other words, DNA does not make one a TS, but certain DNA configurations make it more (less) likely that the person may well develop in that manner.

In that way, it may become much harder to point to a difference between mental and medical in the future.  It will be much more of a matter between DNA factors or and outside/invasive forces (injury, infection, flu).

I used to tease my Xian students there at the Super Huge State University of Science and Technology about their protests of Darwin being two major scientific advances behind other things that they would like even less.  Those being advanced physics, and DNA.  Now that advanced physics thing, forget about it, they couldn't read Darwin correctly (and Darwin wrote very well) I'm such not going to start handing out Einstein, Planck, and Heisenberg to them.  (Much less Chaos stuff)  But DNA, that's very interesting, because what happens if it turns out that so much of what we think is 'choice' and 'free will' (thereby a 'sin' or a 'not sin') turns out to be pretty much encoded into us? (By god itself, who else in their world view could possibility code DNA?, Matter of fact - currently painting themselves into a corner - the fundys here in the States use DNA as proof of "intelligent design'.) Hummm... 

So what happens when most of this turns out to be - not a birth defect - but a birth variation?  Then what happens when we find out how to control it? (Or at least gain the illusion of control over it).

Ok yes - I'l buy that line of reasoning... I'll also apologise for slightly oversimplifying the argument because you are of course absolutely correct in what you say, a gene variation represents a predisposition and not a certainty.

So yeah - I would agree it is a bit of both - nature AND nurture. Point is, by logical reasoning, if you present with the symptom AND you have the gene variation then it is making the case more easy to prove that you may indeed be suffering from the condition.

Now the point where, of course InterAlia can justifiably come back at me is that just because you have the condition it doesent automatically follow that transition and SRS is the right solution for you!

So it is complex area - but what a medical "test" might allow for is a greater degree of flexibilty of approach - rather than the one size fits all that we seem to have at the moment.

of course InterAlia can justifiably come back at me is that just because you have the condition it doesent automatically follow that transition and SRS is the right solution for you!

It's easy for Interalia to do that, because, largely he is correct in that determination.  I can look at your picture, and you could look at mine, and we'd both know that here are two people with a complete and utter understanding that not only does one size not fit all, it might not even fit most.

What I see here, in the all the people I have known in my life with a variation in not just the degrees of GID or whatever you want to call it - I prefer 'gender variance' but that's just me - but in the texture also.  What has turned out to be the 'right' choice for some, is not the best way for others.

Quote from: interalia on December 10, 2009, 07:31:49 AM
This research points more and more toward GID being mental than medical.

Can you produce any of this research?

Everything I have seen has indicated the opposite.

I know wikipedia isn't generally considered reliable, but it's the best index of some of the evidence around.

http://en.wikipedia.org/wiki/Etiology_of_transsexualism#Possible_physical_causes (http://en.wikipedia.org/wiki/Etiology_of_transsexualism#Possible_physical_causes)

I know wikipedia isn't generally considered reliable, but it's the best index of some of the evidence around.

That sentence stands by itself, but there are a lot better researched indexes of work done on this stuff.  But, by definition, GID is in the DSM which makes it de facto a mental deal, no matter how much you may protest the opposite.  That the 'cure' is medical (chemical and surgical) makes it a medical cure, not a medical condition.  In so long as its listed in the DSM its a mental deal.  Period.

Quote from: tekla on December 10, 2009, 04:32:20 PM
I know wikipedia isn't generally considered reliable, but it's the best index of some of the evidence around.

That sentence stands by itself, but there are a lot better researched indexes of work done on this stuff.  But, by definition, GID is in the DSM which makes it de facto a mental deal, no matter how much you may protest the opposite.  That the 'cure' is medical (chemical and surgical) makes it a medical cure, not a medical condition.  In so long as its listed in the DSM its a mental deal.  Period.

Hold up a moment...

Just because something is in DSM does not mean that it is mental - it just means that the people who compiled the DSM think it is mental. (which is a slightly different proposition as my next paragraph will demonstrate.)

Personally I think that the DSM compilers may all be mental themselves ;) - but that certainly doesn't mean that they are. It is perfectly possible that I could be mistaken and later forced to revise my opinion in the light of new information.

Just as the editions of DSM which listed homosexuality as a mental illness are now realised by all but the most ignorant and bigotted to have been mistaken.

It is a sad fact that historically it takes bewteen ten and twenty years for current research findings to be incorporated into mainstream medical thinking. That means that DSM or any similar compendium usually represents the state of the art ten years or more ago, and as we have already agreed there is pleanty of recent research which tends to contraindicate the current inclusion.

One day the DSM compilers will catch up with reality. On that day I sincerely hope that all transpeople then alive will get a well deserved apology for generations of wrongful stigmatisation.

Quote from: rejennyrated on December 10, 2009, 05:11:41 PM
Hold up a moment...

Just because something is in DSM does not mean that it is mental - it just means that the people who compiled the DSM think it is mental. (which is a slightly different proposition as my next paragraph will demonstrate.)

Personally I think that the DSM compilers may all be mental themselves ;) - but that certainly doesn't mean that they are. It is perfectly possible that I could be mistaken and later forced to revise my opinion in the light of new information.

Just as the editions of DSM which listed homosexuality as a mental illness are now realised by all but the most ignorant and bigotted to have been mistaken.

It is a sad fact that historically it takes bewteen ten and twenty years for current research findings to be incorporated into mainstream medical thinking. That means that DSM or any similar compendium usually represents the state of the art ten years or more ago, and as we have already agreed there is pleanty of recent research which tends to contraindicate the current inclusion.

What she said.

As much as authority would love to believe otherwise. Reality doesn't change because they decide to write a book and call it the standard. A disorder does not magically switch from mental to physical because they reclassify it.  Or vice verse. ::)

Quote from: rejennyrated on December 10, 2009, 05:11:41 PM
One day the DSM compilers will catch up with reality. On that day I sincerely hope that all transpeople then alive will get a well deserved apology for generations of wrongful stigmatisation.

I wouldn't count on that one. Did homosexuals ever get an apology?

Julie - I actually live in southern California, but if the therapist won't budge on her requirements then I'm going to look into other sources, and I may give the person you suggested a call to see what my options are.

I've called my initial therapist and told her that the other therapist wants to talk to her to get some background information to hopefully cut the visits I have to have with her to 2, but I also told her that I am looking to just go once, and don't need anymore, so she said she's going to talk to the other therapist and see if she can sway her into just requiring one visit. At this point, I'm hoping that the other therapist won't force me into more than 2, but if she'll allow me to have 1 or 2 sessions before she writes the letter then I'm going to go with that...$150-$300 is better than $450-$600 that she initially wanted, it's still ridiculous though.

~Sarah

Sarah,
What you are going through is insane and completely unnecessary.
Consider coming up to the Santa Cruz CA area for a single visit to a gender therapist. I went to one who charged me $30 on his sliding scale for my second letter. He is a Ph.D and a leader in transsexual treatment here. Dr. Shane Hill.

Maggie

Quote from: SarahR on December 10, 2009, 05:51:47 PM
I've called my initial therapist and told her that the other therapist wants to talk to her to get some background information to hopefully cut the visits I have to have with her to 2, but I also told her that I am looking to just go once, and don't need anymore, so she said she's going to talk to the other therapist and see if she can sway her into just requiring one visit. At this point, I'm hoping that the other therapist won't force me into more than 2, but if she'll allow me to have 1 or 2 sessions before she writes the letter then I'm going to go with that...$150-$300 is better than $450-$600 that she initially wanted, it's still ridiculous though.

I wish you luck in getting it down to only 1 or possibly 2 meetings.

Being devil advocate for a second, doesn't the 1st therapist talking to and persuading the 2nd one to lower his/her requirement due to the experience of the 1st with the patient contradict the whole concept of 2 independent referrer? >:-)

In the U.K GD is only seen as by NHS psychiatrists a mental health issue, which in turn causes far more problems for us.
In some other countries (especially Asia, Thailand, Holland etc) it's not seen that way and therefor treatment is more accessable.