I keep reading and seeing comments about informed consent access to HRT, I thought it may be helpful to see it from the professional view.
Quote:
There appears to be some confusion around the notion of "informed consent". Within the medical community informed consent is considered a core principle of practice and it is considered standard practice to obtain informed consent prior to any medical intervention. To obtain informed consent the physician must be satisfied that the patient has been given comprehensive information about the proposed treatment. This would include information about the expected effects of the treatment, the possible risks or complications and any alternatives to the proposed treatment. In addition the physician must be satisfied that the patient has the capacity to consent to treatment. In other words, the physician must conduct an assessment of whether the patient has the cognitive ability to make a decision and is free from coercion. This can be a very complex assessment and needs to address the patient's ability to understand information about treatment; their ability to appreciate how that information applies to their situation; their ability to reason with that information; and their ability to make a choice and express it. In all situations therefore it is important that a physician conducts a comprehensive assessment to ensure that the treatment being prescribed is safe and appropriate. Informed consent therefore is not "treatment on demand".
A number of clinics in the US and Canada have developed protocols in relation to accessing hormones based on an informed consent model. Examples of these clinics include: Tom Waddell Health Centre (San Francisco), Catherine White Holman Wellness Centre (Vancouver), Fenway Community Health Transgender Health Program (Boston) and Howard Brown Health Centre (Chicago). A core feature of all these protocols is that a comprehensive assessment is made prior to prescription of hormones to assess the appropriateness and safety of prescribing hormones for any individual requesting hormones. In some of these protocols (eg Fenway) the assessment must be conducted by a mental health professional. WPATH has reviewed these protocols and states "The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment."
Wait, are you asking what informed consent is..?
No. What it is.
Cindy, I wonder if a better term for what we've been referring to as "informed consent" would be "informed consent only."
I.e. all surgeons use informed consent for all procedures, but gender reaffirming procedures tend also to have other requirements. (GID diagnosis from a doctor who will often ask us to jump through hoops to prove it to him, etc.)
This is why I posted this. This is informed consent from gender therapists in Australia according to WPATH.
Suzi, there is no requirement for GID, the hoops you jump through are local hoops, not hoops that the professionals use.
That is a major issue with community - professional relationship.
The hoops are not from the true professionals.
I'm trying to deal with that.
Pikachu; hormone on demand means some people will die. I and others in the profession reject that idea as a health concept
Quote from: Cindy on May 09, 2014, 11:10:08 AM
Suzi, there is no requirement for GID, the hoops you jump through are local hoops, not hoops that the professionals use.
I'm on page 104 of the SOC v7, under the section labeled "Criteria for Feminizing/Masculinizing Hormone Therapy". Item #1 says "Persistent, well-documented gender dysphoria".
I have to read that as saying that the WPATH wants a diagnosis of gender identity dysphoria before hormones are prescribed. (Is there some other way to read it?)
Because there is no one presentation for our condition - each of us seems to experience it totally differently - diagnosis criteria is highly open to individual interpretation, and each local practitioner will have their own test, right?
I live in the USA in Pennsylvania.
I did an intake, whent to therapy (3 months), received a GID diagnosis from a licensed social worker, got scripts for hormones and never signed an "informed consent" form.
The PA I go to asked me questions if I knew what the health risks were and the effects of the hormones. He also asked me several questions to access my gid severity and length of time I had it. He is very cute, has beautiful eyes and a seducing voice, almost mesmerizing. He looked into my eyes up close the whole time of the interview. I believe he was looking for eye dilation or some other visual indicator of truth. He just made me hot and love struck :) He is so sexy and exactly my type!
I thought informed consent was.
Making sure the patient was awear of all the INFORMATION before CONSENT was validated. or needing a refferal from a person in an informed position such as a gender therapist.
I think informed consent is wonderful. The deaths averted through preventing trans suicides by allowing people to get medication they desperately need far outway the potential risks of taking the medication which are pretty much exactly the same risks as people who get "letters" from pyschologists. Getting a letter doesn't make hrt more or less dangerous. Worse case scenario you start growing some boobs and don't like them and quit. These places are also very nice and don't pressure people into transitioning unlike many therapists and personal endos. "WHY AREN't YOU WEARING A DRESS and make up! I thought you were a woman!". Ya no.
All you are doing by restricting access to informed consent clinics is forcing kids to self med which is what is actually dangerous (though much less dangerous than letting T have its way with your body), not receiving hormone medication from a liscensed professional with a "letter" (as though the letter automatically makes everything safer lol).
I want to expand on the discussion of informed consent and point out that when I give informed consent for a procedure, the information and the paperwork is usually brief and hurried, and I am often asked to sign things without actually seeing paperwork.
I give informed consent frequently, at least once a week, for either myself or my kid. When I do ask questions I feel like I am being read a script in response, if there is a response. Sometimes the answer is something along the lines of "are you going to sign or not?"
If I were confronted with the decision to give consent that actually required thinking or research and hadn't done it ahead of time, I would be out of luck and I would anger those I go to for healthcare.
Either paperwork has gotten out of control and meaningless in my country, or healthcare providers in my city are all burnouts. I'm sure it might be a mix of the two, but "informed consent" for transgender care doesn't seem to be available where I live and "informed consent" for everything else isn't really informed and is only barely consent.
There definitely are places which practice informed consent (or should I say informed consent only) without therapy. There is a place here where basically you are given a list of the side effects and many possible effects of hormones and then are asked to sign it. You have to have labs. No therapist or counselor of any kind and no intake. I had what was likely to be considered to be informed consent for T. My PA asked me numerous questions. I imagine she could have refused, she kind of wanted to know what my support system looked like, what my general health was, and so on. That was pretty much it, there was no long involved system and I didn't sign any forms (though I think this is typical of a formal "informed consent" system). I had labs. And basically got my T within 2 weeks after I saw her (and one physical appointment). I've heard the clinic above is faster.
The Transgender Resource Center here in Albuquerque (awesome place) did a training on informed consent following the standards set by the Center for Excellence for Transgender Health here: http://transhealth.ucsf.edu/trans?page=protocol-hormone-ready
None of this involves having mental health personnel assess the patient, but most likely involves history taking.
Quite a lot of people will take hormones illegally including the use and exchange of needles so there is great benefit to getting people into the legal system with medical supervision.
Some of the centers you mention would likely do some kind of intake, but that's because they are clinics and clinics in the US typically use intake procedures done by social workers. This doesn't necessarily mean these are in depth procedures to access diagnosis. Some of these may be informed consent in name only. If lengthy psychological or team evaluations are involved, I don't know what the point of informed consent is.
FTM top surgery is sometimes performed via informed consent. I think it is nearly unheard of (in the US) for bottom surgery.
I have no idea how it is practiced in Australia, but the idea that informed consent always (or even mostly) everywhere includes therapy isn't really true.
--Jay
Quote from: Felix on May 13, 2014, 01:09:11 AM
I want to expand on the discussion of informed consent and point out that when I give informed consent for a procedure, the information and the paperwork is usually brief and hurried, and I am often asked to sign things without actually seeing paperwork.
I give informed consent frequently, at least once a week, for either myself or my kid. When I do ask questions I feel like I am being read a script in response, if there is a response. Sometimes the answer is something along the lines of "are you going to sign or not?"
If I were confronted with the decision to give consent that actually required thinking or research and hadn't done it ahead of time, I would be out of luck and I would anger those I go to for healthcare.
Either paperwork has gotten out of control and meaningless in my country, or healthcare providers in my city are all burnouts. I'm sure it might be a mix of the two, but "informed consent" for transgender care doesn't seem to be available where I live and "informed consent" for everything else isn't really informed and is only barely consent.
What exactly is the difference between informed consent and how one normally gets perscribed hrt medication? Most therapists are not doctors who can explain hrt medication.
@Felix, I think in cases where there is just an intake type person (like a social worker), they don't actually know that much. They hand you a form to read, and go thru it with you.
If there is actually a therapist determining if you can take hormones or not, I don't know the difference between informed consent and what's normally done now.
That's not what's going on here with informed consent. It literally is a form that you sign and the doctor (or some other PCP) goes over the side effects and so on and expectations. Informed consent, means you can say you are okay about it, but only if you know what you are saying okay to. I don't see how it is okay to call informed consent where some therapist examines you, but I do believe all informed consent programs require labs and medical hx.
--Jay
Cindy, there is one more aspect for informed consent that is important in Australia - that is alternate treatments have been offered and that the possible advantages and disadvantages have been explained. Medico-legally, this aspect cannot be disregarded and there have bee sufficient precedent in court establishing this.
Other than that, your quote is spot on.
Another interesting little tidbit is that a medico in Australia is obliged to inform a patient about every possible outcome, no matter how unlikely, should the patient demand that information, even if the likelihood of an event happening is one in a million.
I feel the idea of a therapist determining if you should have T is called informed consent, they are completely undermining the whole point of informed consent which is to give you agency in transgender treatment. I'm sure the people who thought of the idea of informed consent would be *really* upset with it.
--Jay
so wait, as long as you have informed constant, you basically bypassed the 3 month therapy requirement? ??? i mean like i got it really bad and i know i wont survive long enough to comeplete 3 months especially now i have to find another therapist who is outside where i live and my insurance difinitely wont cover any therpay outside my state o.o though i dont mind the therapy, it gives me hope i can do therapy but also start my meds o.o
Here is a link to Howard Brown Clinic in Chicago who uses an informed consent model for trans care.
http://www.howardbrown.org/hb_services.asp?id=37 (http://www.howardbrown.org/hb_services.asp?id=37)
I go through them and the basic difference is that as long as you are of sound mind and understand the benefits and side effects of starting HRT and your lab work is clean then you can proceed to start HRT with them. Vs the S.O.C which require a diagnosis of some kind to be made and then the appropriate a treatment plan to be set in place.
Quote from: Penny Gurl on May 14, 2014, 06:43:45 PM
Here is a link to Howard Brown Clinic in Chicago who uses an informed consent model for trans care.
http://www.howardbrown.org/hb_services.asp?id=37 (http://www.howardbrown.org/hb_services.asp?id=37)
I go through them and the basic difference is that as long as you are of sound mind and understand the benefits and side effects of starting HRT and your lab work is clean then you can proceed to start HRT with them. Vs the S.O.C which require a diagnosis of some kind to be made and then the appropriate a treatment plan to be set in place.
so if i prove that my dysphoria is causing my mental instability and current mental diagnoses, have my blood work clean and sign the informed constant, i can proceed with HRT? ??? if thats true than i'm gamed becuz once again, i difinitely cant survive the 3 month process without have]ing near death dysphoric attacks
you would meet with an HRT advocate who explains the process and also takes time to discuss your personal transition plan. Basically they want to make sure that this is a well though out decision, generally you'll go in for a medical appointment first to get your blood draws done then when the labs are back and you have met with the advocate if everything checks out you meet with a medical professional and discuss your treatment options. It's not necessarily about proving or disproving anything it's more about knowing what your body will go though. Granted Howard Brown does some some info on there program that you can download and read over. And if you need any other questions answered you are able to call them and they can give you a clearer understanding of their process.
Quote from: Penny Gurl on May 14, 2014, 06:54:06 PM
you would meet with an HRT advocate who explains the process and also takes time to discuss your personal transition plan. Basically they want to make sure that this is a well though out decision, generally you'll go in for a medical appointment first to get your blood draws done then when the labs are back and you have met with the advocate if everything checks out you meet with a medical professional and discuss your treatment options. It's not necessarily about proving or disproving anything it's more about knowing what your body will go though. Granted Howard Brown does some some info on there program that you can download and read over. And if you need any other questions answered you are able to call them and they can give you a clearer understanding of their process.
my only concern is if the advocates are in my area. i can proved my most result blood panel but are there advocates in the NJ area
It's my understanding that if you wanted to get your services though them you would have to make it out to Chicago at least twice to start. Once for the blood work as they require up to date work though there lab and a second for the advocate/ fallow up medical appointment. But once you are stable medically then you can have your meds shipped.. I live in the suburbs and have them shipped to me so I don;t have to run out there. And I'm sure they would want to have a fallow up some time after HRT starts to make sure that your body is adjusting correctly. But ultimately you'd have to contact them directly to see what they say. I really don't know if they would transfer your lab results, that's something for the pros to decide.
well, unless they can do video calls, imma have to try something else becuz the 3 month wait isnt something i can handle with my current state
Quote from: Umiko Liliana on May 14, 2014, 06:39:41 PM
so wait, as long as you have informed constant, you basically bypassed the 3 month therapy requirement?
There is no 3-month therapy requirement. There is no therapy requirement at all. The current WPATH standards of care are very clear on that.
Any therapy requirement comes from the medical practitioners themselves, perhaps based on an outdated understanding of the SOC.
Quote from: suzifrommd on May 14, 2014, 07:09:02 PM
There is no 3-month therapy requirement. There is no therapy requirement at all. The current WPATH standards of care are very clear on that.
Any therapy requirement comes from the medical practitioners themselves, perhaps based on an outdated understanding of the SOC.
wait, so i dont need 3 months ??? all i know is that i'm not stable enough to go on without transitioning and my endo has made that clear without verbalizing, becuz she recommended i get a psych eval done, my secondary therapist has also commented on what am going to do when i tell him whats going on and everyone around me can tell that something needs to happen or i will break down though they dont know i'm trans. thus why i'm wondering if i ask my secondary therapist for a letter, would he give it to me though he isnt really a gender therapist but does have enough experience becuz 2 of his patients were trans or even my pcp who would be willing to if she could
Quote from: Umiko Liliana on May 14, 2014, 07:15:34 PM
wait, so i dont need 3 months ???
Refer to the WPATH standards of care (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf)), bottom of page 28:
QuoteA mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy—although highly recommended—is not a requirement.
Show that to your doctor, if it helps.
Quote from: suzifrommd on May 14, 2014, 07:24:04 PM
Refer to the WPATH standards of care (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf)), bottom of page 28:
Show that to your doctor, if it helps.
so i show this part to my doctor? i already have well document information and my mental labels arent connected to me be transgendered. i just wanna make sure i do this right before going to my doctor or therapist for a letter.
Quote from: Umiko Liliana on May 14, 2014, 07:28:13 PM
so i show this part to my doctor? i already have well document information and my mental labels arent connected to me be transgendered. i just wanna make sure i do this right before going to my doctor or therapist for a letter.
I can't promise that he'll accept it. The standards of care are guidelines but it's up to each doctor whether to follow it. If you're not sure, I'd call his office and ask.
Quote from: suzifrommd on May 14, 2014, 07:29:59 PM
I can't promise that he'll accept it. The standards of care are guidelines but it's up to each doctor whether to follow it. If you're not sure, I'd call his office and ask.
k, and my last concern. though he had 2 patients who were trans, is it possible he can still write me my letter if i ask him to?
Quote from: Umiko Liliana on May 14, 2014, 07:33:04 PM
k, and my last concern. though he had 2 patients who were trans, is it possible he can still write me my letter if i ask him to?
Again, I'm afraid that's a question for him.
Quote from: suzifrommd on May 14, 2014, 07:38:07 PM
Again, I'm afraid that's a question for him.
ok, last question, could my pcp give me a letter? becuz my endo said have my pcp call her when i'm ready
Let me just add this for those in the Denver / Colorado Springs area, looking for an informed consent provider: http://www.stevehindesmd.com/
My initial prescription for HRT was via this route. Expect an interview, an extensive blood panel and physical exam, and a very informative (even for us "know-it-alls"...lol) briefing on benefits, risks, and realistic expectations of HRT.
Two appointments, about two weeks apart, and I had my 'script.
Incidentally, there are also mental health professionals that will write an SRS letter after as little as a single session over Skype. This varies depending on the case and the person in question, obviously...but there are many people out there who believe that we shouldn't have to "prove" ourselves to anyone to get the care that we need.
if i ask my therapist for a letter even though he doesnt have that much experience, can he still write one for me?
@Liliana:
There is no magic period of time (3 months say). The therapist might not know anything and write the letter. OTOH, getting them to write about something they don't know anything about might be a bit hard!! Some endos don't really go by the letter at all. I know one here that doesn't at all. She talks to you and makes her own decisions. I would clear this up before making an appt with the endo.
@Penny Gurl, yeah this sounds like the kind of ideal Informed Consent type program. I would guess 1-2 physical appts, plus blood tests would be considered appropriate.
The WPATH provides for the Informed Consent approach.
BTW, I did have counseling, but my counselor was not at interested in gatekeeping. I think therapy/counseling is a good idea for many trans people (okay for many people). I just don't like for the concept of gatekeeping. I also believe, from what I have seen, that is more discriminatory towards trans women than trans men.
--Jay
The informed consent part didn't come into play with my therapist, only with my endocrinologist. The endo (in painstaking detail) went over all the risks associated with taking testosterone as well as all the physical changes I would experience. I saw her in her office three times for essentially the same discussion. "Do you really want to take the injections?" Yes. "Do you understand you will be at risk for polycythemia, and that thickening of your blood may cause a blood clot that might precipitate heart attack or stroke?" Yep. "You'll get facial hair and body hair." Uh huh. "Your menses will stop." God I hope so. "Your voice may deepen and you will have growth of your clitoris." Yes I understand. "The shots are painful." I get that. "So you're sure then? You really want to do this?" Yes. "You can change your mind later but some of the changes will be permanent." Yep.
All of that business is getting informed consent.
Quote from: suzifrommd on May 09, 2014, 11:33:49 AM
I'm on page 104 of the SOC v7, under the section labeled "Criteria for Feminizing/Masculinizing Hormone Therapy". Item #1 says "Persistent, well-documented gender dysphoria".
I have to read that as saying that the WPATH wants a diagnosis of gender identity dysphoria before hormones are prescribed. (Is there some other way to read it?)
Because there is no one presentation for our condition - each of us seems to experience it totally differently - diagnosis criteria is highly open to individual interpretation, and each local practitioner will have their own test, right?
I am in Melbourne, Australia. Applied here, the WPATH requirements accommodate the range of GID experienced by those being assessed. What seems to be a block is that if I have not thought of myself as a female from my earliest memory and have opposed by birth gender continuously, the process is seen as (and could be applied to result in) gatekeeping.
My experience here is that I am not at that extreme (I knew that) and the assessment served mainly to discount any other issues. After we had completed that work (mine took a few months - I have more years to cover!!) the informed consent part was very quick and perfunctory. I once referred to it to my therapist (not the Psychiatrist doing the assessment work) that the process is one of "very well-informed consent" meaning the Psychiatrist was well informed about me before I gave my informed consent. She didn't disagree.
Open to individual interpretation? Yes and I think that is right. Necessary? Perhaps. Frustrating? Yes but I persevered as it is the only avenue open here but not onerous in my case. Harmful? For me, no. But I didn't have any issues around access to the process that some encounter or any great and immediate distress arising from GID -just slowly getting to the end of my rope. Beneficial? I'm still out on that one!
A few years ago (and others may recall it better than I can), there was court case here where it was found that sufficient screening/psych assessment may not have occurred. By "informed consent only" standards, arguably more than enough was done. In a legal sense, perhaps not enough. What is left as an unknown is that in cases like that, would more therapy made any difference? Maybe, maybe not. We are dealing with individuals here, not a herd. One size doesn't fit all.
@Spiritwalker, well sounds like the endo was on the informed consent thing, but if you had to get a therapist letter, not so much.
@Emma, I don't know sounds more gatekeeping. Not everyone has experiences from early childhood. In fact, some people do not even know til later in life. In retrospect maybe I did have them from later in life, but I would clearly NOT have been a non-informed consent candidate. Doubt some countries would have let me start T at all. I couldn't figure out if you went thru a couple months or years of therapy though. But I consider months of therapy not informed consent by the way that I have heard the rationale for it to be.
I think coerced therapy does more harm than good. I think it puts the relationship between therapist and client in a position where the person is trying to convince the therapist they are trans enough, instead of concentrating on the working stuff out. It probably even in some cases endangers people's lives where the therapist is not informed enough on trans issues. It discriminates against non-binary people who have non-conforming gender identities by expecting a certain type of transgender narrative. I don't think there is any research that coerced therapy has actually helped people avoid mistakes.
I think the concept, as I understand it is harm reduction: 1. It is safer to get hormones which are controlled medically than off the street somewhere. 2. That the incidence of suicide is very high in the trans community and that hormones could be life saving.
I think cheap (and perhaps free) and available therapy would help more people. Make it available and people will come and treat adults like adults.
I do not believe that the SOC are a legally binding document, but for what it's worth I think that in a session or two it would be possible for someone to determine if the person is legally able to consent (i.e. in a legal way find out if the person is mature enough and sane enough to offer legal consent).
--Jay
Quote from: Cindy on May 09, 2014, 10:27:57 AM
I keep reading and seeing comments about informed consent access to HRT, I thought it may be helpful to see it from the professional view.
Quote:
There appears to be some confusion around the notion of "informed consent". Within the medical community informed consent is considered a core principle of practice and it is considered standard practice to obtain informed consent prior to any medical intervention. To obtain informed consent the physician must be satisfied that the patient has been given comprehensive information about the proposed treatment. This would include information about the expected effects of the treatment, the possible risks or complications and any alternatives to the proposed treatment. In addition the physician must be satisfied that the patient has the capacity to consent to treatment. In other words, the physician must conduct an assessment of whether the patient has the cognitive ability to make a decision and is free from coercion. This can be a very complex assessment and needs to address the patient's ability to understand information about treatment; their ability to appreciate how that information applies to their situation; their ability to reason with that information; and their ability to make a choice and express it. In all situations therefore it is important that a physician conducts a comprehensive assessment to ensure that the treatment being prescribed is safe and appropriate. Informed consent therefore is not "treatment on demand".
A number of clinics in the US and Canada have developed protocols in relation to accessing hormones based on an informed consent model. Examples of these clinics include: Tom Waddell Health Centre (San Francisco), Catherine White Holman Wellness Centre (Vancouver), Fenway Community Health Transgender Health Program (Boston) and Howard Brown Health Centre (Chicago). A core feature of all these protocols is that a comprehensive assessment is made prior to prescription of hormones to assess the appropriateness and safety of prescribing hormones for any individual requesting hormones. In some of these protocols (eg Fenway) the assessment must be conducted by a mental health professional. WPATH has reviewed these protocols and states "The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment."
Yeah red tape nanny state BS. This is the reason i self medicate. I would prefer to be under a doctors care but they make you jump through too many hoops so I self medicate and I may have to self castrate.
Quote from: suzifrommd on May 09, 2014, 10:55:04 AM
Cindy, I wonder if a better term for what we've been referring to as "informed consent" would be "informed consent only."
I.e. all surgeons use informed consent for all procedures, but gender reaffirming procedures tend also to have other requirements. (GID diagnosis from a doctor who will often ask us to jump through hoops to prove it to him, etc.)
Exactly! String you along just to take your money. They don't care about people like us so they feel justified ripping us off.
well honestly, my endo just said go to her when i'm ready which means i just get the informed consent, have a note from my doctor saying i'm stable enough to start hrt, yada yada yada but it stills seems like i'm being put through to many hoops and all my therapists and doctors see that clearly i'm trans from all my attacks, how i conduct myself, and my speak patterns, hell i'm asked on a constant bases from a friend on how to wow her boyfriend or what he is thinking and i'm like "girl, i have no idea" and she is like yes you do cuz your a male. there are so many other things but thats just the tip. i even got 2 therapists just to get through my week without losing my mind. i just hope this works out becuz quiet frankly, i dont know how long my mental will last if this keeps up
Quote from: Amy1988 on May 15, 2014, 08:34:46 PM
Yeah red tape nanny state BS. This is the reason i self medicate. I would prefer to be under a doctors care but they make you jump through too many hoops so I self medicate and I may have to self castrate.
Quote from: Amy1988 on May 15, 2014, 08:37:58 PM
Exactly! String you along just to take your money. They don't care about people like us so they feel justified ripping us off.
Firstly, attitudes like this are why trans people have a dubious reputation in the wider community.
Secondly, try dealing with professional gender therapists, ones with established and well known reputations.. I did and have had no issues - although I do seem to be a little more pragmatic and realistic than some.
Quote from: Amy1988 on May 15, 2014, 08:34:46 PM
Yeah red tape nanny state BS. This is the reason i self medicate. I would prefer to be under a doctors care but they make you jump through too many hoops so I self medicate and I may have to self castrate.
Really good reason why some people are for a real informed consent (only) versus these kinds of "pretend' informed consent that are actually just some kind of "streamlined hormone letters" (some do not sound that streamlined).
I am really strongly for harm reduction and I think real informed consent really does this.
--Jay
Quote from: Amy1988 on May 15, 2014, 08:37:58 PM
Exactly! String you along just to take your money. They don't care about people like us so they feel justified ripping us off.
I'm sorry you feel this way. Most health care professionals I know are passionate about their work and only wish the best for their patients. Due process (correct diagnosis, etc) takes time, and I understand your frustration at what may seem to be hoops to jump through.
I've seen all too many items people shop around till they get the treatment they want and make their long term situation worse.
I'd advise against self castration unless you're keen on bleeding out - arterial bleeds aren't fun to stop unless you know what you're doing, and just putting a rubber band over them will eventually put you in hospital and make you a sideshow when you're admitted.
Quote from: EmmaD on May 15, 2014, 05:50:54 AM
What seems to be a block is that if I have not thought of myself as a female from my earliest memory and have opposed by birth gender continuously
IMO, any practitioner who thinks that not having childhood gender issues is any indication at all of whether someone is transgender is seriously misinformed and should not be treating transgender clients.
Of course I tend to have a lot of extreme views...
Quote from: suzifrommd on May 16, 2014, 07:57:07 AM
IMO, any practitioner who thinks that not having childhood gender issues is any indication at all of whether someone is transgender is seriously misinformed and should not be treating transgender clients.
Of course I tend to have a lot of extreme views...
You?! Extreme views?! :)
Well maybe but I agree and it's one reason I don't like the gatekeeping model.
--Jay
well, all i know is informed consent is whats saving my tail from hitting the concrete
Quote from: luna nyan on May 16, 2014, 06:49:13 AM
I'd advise against self castration unless you're keen on bleeding out - arterial bleeds aren't fun to stop unless you know what you're doing, and just putting a rubber band over them will eventually put you in hospital and make you a sideshow when you're admitted.
Seconded! I hope you don't get this desperate, but if you do, plan to do it very close to an emergency room because you will almost certainly need medical attention immediately after; likely surgery. And if you have any hopes or plans for genital reassignment in the future, this may severely complicate it or even make it impossible. I've seen someone's story and before and after pics on another forum.