delete this bs
The whole purpose of informed consent is to allow a way for those of us who aren't "trans enough" to present as a classic transsexual...it provides a protection for both the the*apist and the provider. Informed consent means you know the consequences, good and bad, and accept the risks and outcome, should you change your mind later.
Asking to talk to other dr's, your parents, etc is just flat wrong. She could ask, but to make it a condition of getting the letter, is WRONG.
When she decided to not write the letter, she should have told you. Keeping you in the dark, or in suspense, is very unethical.
You may want to consider reporting her to the authority which issued her license.
As to your provider...talk to him/her, calmly explain the situation, and tell them of your concerns about stopping hrt. You might think s/he'd stop hrt, but if you are open and calm about it, they should give you time to find another the*apist. (And yes you should find one. Do NOT go back to the current one, exxept if she has the letter in-hand; NOT to talk. S/he has already lost your trust methinks.)
Your concerns are entirely justified and I feel you handled the situation correctly.
I also think you'd be wasting your time and money trying to make this work out with this particular therapist any further. Unless you can be given a legitimate reason why she's dragging feet about it, it's time to kick the dust off your feet and go elsewhere if you can. I really hate to say this also, but if she really did word it exactly as "people who start TESTOSTERONE via informed consent do not fare well"... my objective impression is that she has a personal issue with FTM's and it is clouding her judgment of your care. That should never happen under any circumstance. That is dangerous and highly unprofessional and I completely agree with Beth, you should definitely report her conduct to the licensing board. Don't allow this abuse to occur to anyone else if you can help that. And you surely can just by creating record of the misconduct.
And incidentally, her claim is without merit. I'm 99% informed consent and doing great (maybe that just chaps their butts that they're just unnecessary for some of us, I don't know). The only thing I had to do with a therapist (actually, the presiding head M.D. Psychiatrist overseeing the entire mental health department of Kaiser. Before which a year previous I'd been basically lost in the shuffle of a LCSW at the same place who clearly wasn't going to help me. Didn't even remember me from two weeks previous, or else pretended not too... trying to peddle me off into other things I just really didn't need and was not there for) was because of Kaiser's policy to cover their butts. It was simply an assessment to gauge whether or not this was a sudden decision possibly brought on by mental instability (and that is a more than reasonable and fair precaution IMO. It is as much to protect us as it is to protect them). It wasn't and so the same evening I received a call with the decision, stating she didn't believe I needed therapy for this as I'd clearly had it all figured out on my own (and I also was perfectly honest about my preference against therapy during our meeting. Honesty is always better than trying to reinvent the facts, until or unless you have good and justifiable reason otherwise. But I will warn you that they are trained to pick up on dishonesty or hesitation and THAT is a sure-fire way to guarantee a slew of therapy, not to mention outright "gate-keeping") and she had even already set up my second appointment with the Endo for me. That was that; quick and painless. I only wish it were the same experience for everyone. That's how it should be. Patient's will should always come first until or unless there is a LEGITIMATE reason not to handle it that way. And if there is, you have every right to be told that reason or reasons without any beating around the bush about it/them. You are paying this person for a service, don't forget that. For your time with that professional, you are their boss. You have the power. Use it. And if you're unable too because of unprofessional conduct or otherwise, that's a problem you do not have to and should not have to put up with.
Furthermore, I would be very cautious about signing anything. The only reason I can think of for why she'd need you to sign releases to obtain your medical information and only now would in fact be to contact your doctor(s) for nefarious purposes. By law they're not even allowed to discuss you with ANYONE else including your doctors until or unless you sign those release forms (this DOES NOT include letters for T, however. Those are to be written and to be given to YOU, so that YOU can then present it to your medical professional and for it THEN to become part of your medical records. NOT any other way). I really wouldn't do it. She clearly has no interest in following-through. And two years? Woe.
I truly am sorry you've had a negative experience but don't let this snowball any further. Get away from this woman. Her conduct is extremely unprofessional. And I'm simply shocked moreover because she's one of us herself. Talk about gunning for your own. I bet she'd not have appreciated someone just like herself in the reverse hanging it above her head and having to act the trained monkey to get it either. That's wicked. Or maybe that's the problem, maybe that did happen and now she's exacting revenge. I don't know. I'm not keen on trying to figure people out like that. In any case, it's wrong and you don't have to put up with it.
Since you are already on T and with a record of informed consent (hopefully you do have a copy), you don't have to continue therapy at all unless of course you wish too. A letter from your present informed consent physician stating you are already on it and the reason why is enough should you ever have to find another provider for this care, for whatever reason. It's likely better to be from an Endocrinologist however, as they're more capable of providing specifications about the target range of total testosterone as well as other particulars.
As for already having told your prescriber to expect the letter, I'm not so sure what you should do. Perhaps you don't have to do anything. If you're already informed consent and you've signed for that, and its part of your record, that should definitively be the end of it and no further explanation should be necessary for the lack of the therapist's letter. I also don't have one from a therapist but my Endo's letter has proved more than satisfactory (although in hindsight, I do really wish I'd have requested the inclusion of the other reasons I need it just in case. Without it my insulin and cortisol just go nuts and sickeningly so. I'm not just saying that. But alas so far that has proven unnecessary. Hopefully I won't regret that oversight).
What they (Beth and Magnus) said... your current therapist is obviously not meeting your needs, and being honest with your endo about your (apparently deranged) therapist might be valuable.
However, I do differ with Beth on coming clean to your endo pre-emptively. It is likely that your therapist (for fear of a lawsuit) will not even contact them... if they are already working with you and if you have no issues getting your next dose, you're probably in the clear. If they bring up a conversation/letter/etc from your therapist as a possible reason to discontinue hormones, that would be the point where you should tell them everything. Right now this is a matter between you and your therapist, and you are under *no* obligation to bring up such private matters with your endo, who is outside of that relationship. I also believe it would be a serious breach of ethics for your therapist to contact your endo to retaliate against you, but then I'm not a lawyer.
*hug* I'm sorry you are having problems with your current therapist, and I wish you luck in your search!
Your permission to release medical records can be rescinded in writing to whoever you signed the papers with meaning to your therapist or her office.
If you need a top surgery letter just pay $320 to Dr. Graham. Skip this bitch.
You are very welcome.
Rescind those releases and be sure you obtain a copy of those forms of retraction also. But given that your prescribing physician is at least abreast of this situation and in her own words, I don't think you need to be overly worried at least where that one is concerned. She is also correct in her assessment (its telling how so many agree on that point). She is unprofessionally projecting and whatever it actually is about, it's clouding her judgment big time.
Some do need the old and rigid standard, while others simply don't. We're all individuals. There isn't, undoubtedly contrary to some people's feelings, a one-fits-all. IF you are certain, that's that. You're ready. IF not, IF you still reserve doubts (you know, beyond the typical jitters we all experience) then you're not and need more reflection and careful consideration. BUT, you're already on T and yes, what's done is done. If you're doing well so far, you already know it was the right decision for you to have made. And medically, it isn't a good thing to be swinging on it and off of it in the beginning (developmentally speaking). For her to even insinuate that eventuality is just messed up and clearly reflects the fact that she doesn't have YOUR best interests at heart.
No matter what, ultimately there will always be a risk of later regret. It's just part of the package. BUT, not very often does that actually happen. Informed consent or no. Therapy or no. At some point you're going to have to dive right into the deep-end to actually and really know for sure; it is exactly like sink or swim. And you've already done that with T. You can't undo it (well, technically you could still... well you know what I mean). But that's what she wants to try and do by the sound of it. It just isn't supposed to work that way. And she has no legitimate reason to try and do that either or you'd already know of it.
So... shop for another therapist, if you even want to actually keep up with that. You have absolutely zero obligations to continue with this one. After you've gagged the release forms, you can be done with her and that's what I personally would do if I were you. No matter which order you decide to medically transition, that's your business and your right to dictate. It's nobody's damn business but yours. That's going right back to that truth of it's different for us all. Not everything is going to work out in this specific way or that specific order for everyone. And you shouldn't have to prove how trans you are or not either. If you're questioning and have been for a long time or you KNOW... you're trans. Something she should know well and good.
Just some more friendly advice though, in the future really consider as many of the angles as you can and before signing anything. Wait and get an objective opinion there if you need it. I know it's not always that simple, but never sign anything otherwise (always trust your own gut-instinct it will rarely lead you astray). It is never a good idea to sign something just because you feel pressured. Many a person has had signed forms come back to haunt them. It is always OK and well within your rights to ask why they're necessary and also and exactly how they will be used first, especially in medical matters. Hell, I'm sure you could request in writing from said interested party exactly that in order to prohibit anything more from being used of them than what they claim they will.
Pertaining to this immediate situation, a therapist has absolutely no business with your medical records. Her area is completely outside of the medical scope. A Psychiatrist, on the other hand and as in the kind dealing with potentially dangerous (you'd be surprised) and mind-altering medications, yes they certainly would need that information to properly judge care in that way. But not a therapist.
I don't want to alarm you I'm just trying to clarify these facts. I do believe everything happens for a reason so hopefully that reason ultimately winds up to your benefit somehow. But please do follow your instincts here and do what you feel best for yourself.
There is also no law against not following 'WPATH' and you certainly don't have too. I'm proof of that. Many others are also proof of that. If it doesn't fit or work for you, you don't need it.
QuoteWith regard to signing papers, I already signed the release papers because my therapist threw them on me on Wednesday and I felt cornered. I'm regretting signing them...
Don't ever allow yourself to feel cornered...or, if it happens, ask to think it over--offer to take the forms home and bring them back "tomorrow" or whenever you might feel like it.
Quote from: chipper on November 01, 2013, 03:49:01 PM
With regard to signing papers, I already signed the release papers because my therapist threw them on me on Wednesday and I felt cornered. I'm regretting signing them... maybe I'll contact the testosterone prescriber, pcp, and psychiatrist and ask them not to release information- or would that arouse suspicion and be overkill? I also have copies of my informed consent record from my testosterone prescriber so I should be in the clear on that front.
If the papers you signed are from your therapist, then the only information shared would be from her to your medical providers, not the other way around. Unless you also signed release forms with your doctor allowing them to send information to your therapist. I know I had to get release forms from both, specifying exactly who they had permission to share my information with. I actually had to sign a release form for
myself before my first doctor would even send copies of my bloodwork to me, which I found kind of ridiculous, but they were pretty crazy.
I would definitely agree with others to rescind those release permissions, and get copies made for yourself. After you do that you can either look for a new therapist, or not go to therapy at all. Since you've already started T with informed consent, therapy is not a requirement for you, so you should only go if you feel like you need to.
Quote from: Beth Andrea on November 01, 2013, 08:53:45 PM
Don't ever allow yourself to feel cornered...or, if it happens, ask to think it over--offer to take the forms home and bring them back "tomorrow" or whenever you might feel like it.
This. They can't force you to allow them to share your personal information. That's completely up to you. If they try to force it on you, that's a sign to look for someone else.
In all seriousness, chipper, two years is more than sufficient time for your therapist to make up her mind about your suitability for HRT. Especially since she is TS herself.
I am sure that request to talk with your partner or parents has to do with assessing your support network.
Don't worry too much about the informed consent. The reason they exist in the first place is because of over-zealous gatekeepers. I am all for therapy, but it has to have benchmarks and entirely open communication.
Hi, chipper.
It does sound to me like she might be a therapist who is not happy that Informed Consent took her "power" away. So, really it doesn't make sense that she is keen on WPATH as they are the ones that now have "informed consent" in the SOC.
I would do two things immediately. Leave a voice message on her phone telling her that you are revoking "ALL RELEASES OF INFORMATION" YOU HAVE SIGNED FOR HER TO "BOTH RECEIVE AND GIVE INFORMATION FROM/TO OTHERS". I would even mention the date and time of the call on my message. Email her and tell her the same thing. With the email you will have a time stamp. I would also write a letter and mail it saying the same thing.
IF she communicates with any of your providers her licensed could be easily revoked. Confidentiality is HUGE in health care, especially mental health. This means she can't even send a positive letter to your HRT provider at this point. I really can't imagine her being stupid enough to step over this line.
Obviously, you would have to call the providers she sent releases to so that you can tell them that you revoked those releases and you don't any records sent to her. Or, you can just let that go, if it is too stressful. The important thing is that she is not allowed to contact them.
I'm sorry this whole thing happened. Therapy is a place for support, not a place to create angst. Try not to worry. Revoke those releases and then she will have no power. She has no power, anyway at this point, you already have your testosterone.
WPATH standards for top surgery still requires a therapist letter. Of course, you can always find surgeons who don't follow the Standards of Care, as others have said.