Susan's Place Transgender Resources

I certainly don't want to start and argument, more an intelligent discussion what is your opinion of  'quick' informed consent (basically HRT on demand no questions asked) 'true' informed consent, ( several visits to ensure you understand what you are doing) or extensive psychotherapy so that your problems are aired and discussed fully prior to HRT/surgery?

I come from this issue by comments I have had (not on this site) that quick IC is preferable - even if a number of people suffer or even die from making the wrong decision.

I find that unacceptable, I also BTW find gatekeeping, as generally understood by the community unacceptable. I prefer a model of community based therapy leading to psychiatric informed consent, followed by ongoing community therapy as needed.

Now a given is that everyone involved has to be properly trained and not the fly by night or Bible bashing medical community, but trained sympathetic therapists.

If you have detransitioned or have post op or even post HRT regret how would you like the system changed to a point that would have helped you?

Your thoughts?

I'm not in the category of people whose opinions you are seeking on this, but I think as long as we can find some way to ensure that informed consent is actually informed, it's okay. It wouldn't even be faster than more orthodox paths if we did it right, but it would be more respectful. Some people are clearly harmed by some elements of the standard process and would benefit from a different model.

It seems rare for ftm's to detransition, so again, I know my opinion is flimsy here.

OK.... in summary

Gatekeeping = wrong.

Quick informed consent = Here is my money, I want to buy that diagnosis.

Proper informed consent = What everyone SHOULD  be going through


Now the rant.....

From what I can see, there are a lot of people who really lack self-belief and who are buying the diagnosis they want and whilst they might have GD many of them have other issues that need to be treated. I think that many "buy" GD as an escape from their current problems because they will be a new person with a new life and all those problems will not follow them. Except they soon find out that transition solves only ONE problem and adds a few more. There are even therapists that will sell you informed consent letters for GRS on the basis of $120 and a phone interview. Somebody challenged me on that a few days ago and I offered to provide a list of such therapists.

Many people seem to regard "proper informed consent" as gatekeeping because somebody is not doing what they want on demand and it seems to be the younger transitioners more than the older ones. Maybe because they are young they lack patience or perhaps they are used to getting what they want. It might even be that the amount of duff information on the internet - you must transition before you are 12 or there is no point - is having an effect.

All I am certain about is that the amount of post-op regret will increase due to people making the wrong decision to have GRS or having massively unreasonable expectations about what GRS brings.

In England we do gatekeeping and it's just cruel.

Quote from: kira21 ♡♡♡ on June 14, 2014, 06:34:19 AM
In England we do gatekeeping and it's just cruel.

On what basis do you say that?

OK, Cindy, you asked.

First, our objectives. What would screening try to achieve. Here's my take:
* Want to make sure anyone with gender dysphoria receives prompt, appropriate care.
* Want to make sure that we're not ruining lives with a medical intervention. Want to prevent suicide or serious mental illness or trauma as a result.
* Want to make sure that ill-informed practitioners (which are, IMO, unavoidable), don't substitute their judgment for those of a competent patient who knows what she needs.
* Want to make sure we don't destroy the physical health of the patient by dispensing medication that damages her.
* Want to make sure transgender patients have the opportunity to be fully educated about all their options.

OK, second, and almost as important, here are things that are NOT our objectives:
* To avoid disappointment. (Disappointment is unavoidable and a human experience from which people can grow).
* To prevent lawsuits (Should not be a consideration in medical treatement).
* To tell patients what is good for them. (IMO, no doctor, no matter how expert, insightful, or experienced can know for sure what's good for a transgender patient).
* To exclude people whose transition might be unsatisfactory (IMO, transition is a RIGHT not a therapy, and is not "by prescription only").

Now here's the answer to your question:

1. There should be a standard set of literature made available to transgender patients. A patient who presents for HRT should be encouraged (but not required) to read it.  It should contain information about the effects and risks of HRT, and also whatever knowledge might help someone successfully transition.
2. The patient should be given the option (but not the requirement) of a psychological screening. It should be explained to the patient what psychological conditions and limitations might prevent them from making a competent decision and give her an opportunity to be screened for them. Upon receiving this information, the patient can decline or accept the screening.
3. Upon receiving the information in 1 & 2, the patient should be given access to HRT on a timetable of her choosing within medical safety guidelines.

What about people who are not mentally competent to make decisions about their care? Well, treat them no differently from ANY OTHER PATIENT who presents with ANY OTHER CONDITION. When any patient is a danger to herself and others, the doctor can make a recommendation for psychiatric care. Doctors do that for anyone they come in contact with who fits that description. But they also provide care that is needed.

Is this the sort of thing you were looking for?

A study on post-op regret based upon how the patient initially obtained a transgender diagnosis would be highly beneficial.  I imagine that those who entered the process via quick informed consent would have a far greater percentage of post-op regrets.

I fall somewhere in the middle on this subject.  From what I've seen, gender issues are so destructive when hidden that by the time someone seeks treatment, they are often also suffering from other issues - depression, stress, suicidal tendencies perhaps, family rejection, crumbling marriages, financial woes etc.  These have to be addressed too, and with quick informed consent there is no attempt to even identify, let alone address, these problems.  Quick informed consent also allows those who are misdiagnosing themselves access to some life-altering treatments, and let's face it, who hasn't misdiagnosed themselves by looking at the internet and talking to equally ill-informed peers?

But on the other end of the spectrum, gatekeeping (which, as I understand it, is where the therapist personally has to "approve" the fact that the patient is suffering from gender issues - i.e. the therapist is no longer objective, but subjective) is equally bad in that it's an archaic roadblock based upon outdated information.  We know far more about gender from a medical perspective than we did when gatekeeping was the norm, and it is unnecessarily cruel.  Imagine having a patient with a broken leg "prove" that he can't walk before being given any treatment whatsoever?  An extreme example, but it conveys the point.

True informed consent is, in my mind, the only way to go.  You're having a professional double check that you're not way outside the diagnostic spectrum, slow the process down a little (because we all get excited and want to get started on the medication as quickly as we can), and encourage a little self-examination to make sure you understand what you're getting into.  There is nothing wrong with having a few sessions with a therapist to make sure you're starting out on the right track.  It's hardly a huge hurdle to overcome in terms of time or cost (and if one can't afford a few hundred bucks for a few sessions of focused therapy, how does one expect to afford the far higher costs of successfully transitioning?)

Of course, I don't advocate for one way into the system either.  There are people I know who have intelligently and thoroughly researched their condition and options, and who would benefit from quick informed consent.  There are others who have bigger problems to worry about that gender, or who have some crazy misconceptions about what transition is, who could use some hardcore gatekeeping.  Most of us, though, seem to fall into the middle where true informed consent is appropriate.

I'm just starting HRT and I'm making sure I'm going to continue visiting my therapist throughout; I want to make sure that I have someone keeping an eye on me so I don't end up in the "regret" column when all is said and done.  I don't want to ever detransition or have any regret - to me, that is a sign that someone (me, the therapist, doctors, whoever) made a mistake.  And as with all medical treatment, mistakes really should be unacceptable.  If one takes transition at a safe and monitored pace, the chance of making a mistake is minimized.

I personally think that informed consent must be truly informed. Information presented in written and perhaps visual form and that should be enough for HRT. I do not think multiple visits are needed although I can understand perhaps a second visit which gives a person time to think through all they have been told/shown.

Surgery on the other hand, should require informed consent AND screening for other possible things which could interfere. I see no problem requiring a year of RLE preceding that surgery.

My reasoning is that HRT is less invasive and will often have the person either find it is wrong for them or that is what they needed all along. It is largely reversible without too much hassle if it is the wrong thing.

Surgery is not reversible and has much greater invasive impact. The regret from surgery, if it happens, will be much greater than the regret of HRT.

Quote from: yvvrvt on June 14, 2014, 06:52:17 AM
On what basis do you say that?

Well,  it's an opinion,  but they space the appointments you have three months apart.  So in a year you will have 3 or 4 in year.  I spent all of mine talking about the merits of progesterone,  which is funny as they are supposed to be psychiatrists,  not endocrinologists.  They didn't really get to know me at all.  Tbh,  it's nowhere near enough to get to know somebody.  What they were really doing is making people wait it out.  During that time,  which for me was a little over a year (and I was ft way before I had my first gic appointment, had changed my passport gender, name, etc.) but for others I know has been up to 4 years,  you are supposed to present in your desired gender everywhere.  I can't imagine being told that I had to wait four years after presenting in my desired gender before getting hormones. To me that is cruel.  I hear of people having their time 'reset'  for not adhering to their idea of presenting such as not wearing make up or not wearing a skirt. 

People should be allowed hormones as they transition.  2-3 years after does not seem like informed consent,  it seems like gatekeeping. Particularly when you are not putting in any good counselling in that time. It's not 'working through things with you'  it's 'go away and wait it out'  time.

That's why,  but like I said.  It's an opinion. 

Cindy,

You've most certainly given a minefield question here.

Firstly, let's define what informed consent is in general medico-legal terms.  I'm going to paraphrase what is generally assumed in a court of law in Australia.

Informed consent is consent given by a person of sound mind and comprehension to undergo medical treatment for a diagnosed condition.

To fulfil these criteria:
1.  The patient needs to be able to understand their condition ie be mentally competent.
2.  A diagnosis of some sort has to be made.
3.  A treatment proposal, with salient outcomes, benefits, disadvantages, and side effects has been discussed and understood.
4.  Alternative treatments have to have been discussed.

For purely physical things - broken bones, cysts, tumours, etc, these criteria are relatively easily fulfilled.   When we start talking about mental health issues, then it becomes somewhat more nebulous.

Going back to transgender treatment, the issue is how to correctly arrive at a diagnosis in timely manner - not every gender identifying individual is definitely truly TG - other issues may be causing the presentation.

Gatekeeping as a means of diagnosis is wrong in my opinion, but neither is the case of handing out scripts willy nilly - there has to be a happy medium in there.

Quote from: kira21 ♡♡♡ on June 14, 2014, 09:32:26 AM
Well,  it's an opinion,

Indeed. So here is mine. I was fulltime before I went there. In the space of 12 months I had seven appointments, including assessments, endo, followups and surgical opinions and I am talking Charing in my case. I found people willing to listen and help.

I attend a large trans group on a regular basis so each month I touch base with a couple of dozen trans women and the ones who have problems with GICs are the ones who seem to find problems everywhere. Three others had bad experiences with GIC staff in two clinics and they complained and the clinic apologised and assigned other staff.

My experiences are totally unlike that those you (and others) describe. The reason I get annoyed by negative descriptions is because I use to read them and believe them. They convinced me I could not ever transition. In short, they stopped me from transitioning 10 or more years ago. In the end, what I found was people willing to help me as long as I did not go in there and tell them how it was going to be.

There are people out there reading this stuff now. I want them to know that the horror stories that are routinely presented are not true. That other people (me and 2 dozen others) have been helped and UK GICs are not the horrors that people often paint them as. I do not want others to suffer delayed transitions out of fear as I did.

I'm probably going to be asking a very dumb question.

What does Gate keeping mean?

Someone other than you holds the keys (decision) on how, when and/or if you can medically transition.

Informed and really extensive and verifiably well understood consent is an absolute must! Much of the psychotherapy turns out to be really quite predatory intentional gatekeeping for the purpose of using up the hard earned funds of the transitioner which creates more angst than is necessary from what I've observed. One thing missing in this conversation is the fact that at trans group meetings and trans support web sites there is often a lot of mindless group-think BS accompanied by peer pressure and the expectation that everyone will transition completely in the prescribed manner like others have, some are extremely militant and insulting about it as if their own transgendered credibility as a man or a woman is somehow dependent on others joining their ranks. I am dealing with just one such young friend whose name I won't mention who had succumbed to just that mentality and who had gone through the numerous surgeries and was damned close to suicide feeling as if her life had been totally destroyed when we first began to connect and work through it via email and I'm angry about what has happened to that dear child. So I really don't think informed consent is the big elephant in the room here.

That's really good to hear that some people are getting more out of the process from the gic.  Unfortunately my experience with the gic (notts) is that they have not identified any councilling groups or anything like that for me.  They have not even mentioned it and I think that should be part of the process. 

I would still really like to talk about issues with a trained professional and I have not been offered the opportunity to do that with the gic and it should be a requirement.

I am not sure if you are blaming the person being treated when you say they find problems everywhere,  but if you are then I,  having spoken to the people I was referring to would not find that very fair,  but I could be misreading what you mean. 

I would not say the 'horror stories'  are not true (unless you think they are all lying - myself included.  I wouldn't really even describe mine as a horror story and if I had to do it again it would not put me off transition, it's just a disappointment and not how it should work. What I think it might be better to say is mixed bag.

Quote from: LordKAT on June 14, 2014, 12:28:38 PM
Someone other than you holds the keys (decision) on how, when and/or if you can medically transition.

And that is their sole purpose,  to decide who gets in. 

Quote from: kira21 ♡♡♡ on June 14, 2014, 12:55:13 PM
I am not sure if you are blaming the person being treated when you say they find problems everywhere,

Let me give you one example of someone I know. She regards most people as ar*eholes and has a very short temper. She argued with a series of doctors that they should simply give her hormones because she was a grown up. After going through several GPs she rolled up to the GIC argued and rowed with their staff because they would not give her hormones on her first visit. After another two visits of this they chucked her out. Last I saw she was self-medding and blaming doctors and GICs. It was all their fault.

I have known of others who pull stuff like this but most people I know just went to the GICs and talked to them and told their trans story and went on to hormones after the second visit. That is the story for most transwomen I know.

As for chatting and counselling you are better off getting that from your local mental health services. The GICs seem to be concerned with the process of transition.

I think with hormones, informed consent is preferable because the effects are (mostly) reversible, at least for mtf, idk about ftm maybe it's the same.  Many suicides could have been prevented if the victims just would have been able to get on HRT before they gave up on life, it almost happened to me.  HRT, if it gives you psychological relief, can actually let you know pretty much unequivocally that it is the right path for you.  It can also make transition easier, make patients have to deal with fewer indignities, less shame, and can curb violence in some cases.  There are just a lot of substantial positives HRT can potentially provide if you have GID, and comparatively so much less risk.

Surgery, on the other hand, I feel does need some gatekeeping.  Given the success rate now, I don't think it should be any more stringent, and I certainly don't think it should be any less.  Most of the cases of regret I have read about have had either the gatekeepers not doing their jobs very well, or the patient lying about their feelings (sometimes to themselves.)  If the process is followed correctly, the chance of post-surgery regret is slim to none, and that is how we all should want it to remain.

Quote from: LordKAT on June 14, 2014, 09:03:01 AM
I personally think that informed consent must be truly informed. Information presented in written and perhaps visual form and that should be enough for HRT. I do not think multiple visits are needed although I can understand perhaps a second visit which gives a person time to think through all they have been told/shown.

Surgery on the other hand, should require informed consent AND screening for other possible things which could interfere. I see no problem requiring a year of RLE preceding that surgery.

My reasoning is that HRT is less invasive and will often have the person either find it is wrong for them or that is what they needed all along. It is largely reversible without too much hassle if it is the wrong thing.

Surgery is not reversible and has much greater invasive impact. The regret from surgery, if it happens, will be much greater than the regret of HRT.

Agreed.

Cindy, one question because mostly I agree with you. When you say "psychiatric informed consent" are you thinking of a psychiatrist specifically or perhaps a psychologist or other experienced therapist as well? In my area psychiatrists don't do therapy and are quick to reach for the prescription pad. Insurance makes it almost necessary for them. I've only known one who did therapy and I know a lot of psychiatrists.

Excellent discussion, thank you.

Dee, my mention of a psychiatrist is purely from a medically trained area, a qualified equivalent would to my mind be the same - as long as they are fully trained! That BTW is one reason I'm raising the topic. How to ensure therapists are fully trained to deal with us and not just use us as cash cows (or cash bulls ;D Felix!)

A problem I face and others is the diversity of clients, yes many of us are educated, informed and very capable of making a decision and have very clear and obvious GID that is easily treated with support, HRT and surgery (if desired), as Suzi implicated.   Other clients are not, they can have profound problems, how do WE (as a community) tell professionals to deal with such clients? They need and deserve respectful treatment but how do we give it?

A one model system doesn't work, but a split model works to the disadvantage of many. How do we propose models of treatment to resolve that?

I think it should be a case-by-case approach, with the caveat that the initial triage should be conducted by the primary-care physician, provided that he/she has know the patient for a couple of years.

Why you may ask ? Well, in my opinion the primary care physician is the best person to vouch -or not- for the patient health status and cognizant abilities.

So, in this model, it would be up to the primary  care physician to recommend:

1) a quick interview with a physiologist for concurrence with a GO for SRS/HRT,

2) a 4 session with a psychiatrist to make sure patient is emotional and mentally stable before going with a GO for SRS/HRT, and

3) when patient is deemed to have deep undelaying psychiatric issues, the GO will be given after the patient is stabilized.

Quote from: peky on June 14, 2014, 05:52:39 PM
I think it should be a case-by-case approach, with the caveat that the initial triage should be conducted by the primary-care physician, provided that he/she has know the patient for a couple of years.

Why you may ask ? Well, in my opinion the primary care physician is the best person to vouch -or not- for the patient health status and cognizant abilities.

So, in this model, it would be up to the primary  care physician to recommend:

1) a quick interview with a physiologist for concurrence with a GO for SRS/HRT,

2) a 4 session with a psychiatrist to make sure patient is emotional and mentally stable before going with a GO for SRS/HRT, and

3) when patient is deemed to have deep undelaying psychiatric issues, the GO will be given after the patient is stabilized.

Good plan Pecky, probably makes way too much sense for the world we live in today.

I don't think it should be a set number of sessions. I don't think HRT should need any sessions. Surgery on the other hand should need a pass but not a set number. I had one where all we did is stare at each other for an hour, well 55 minutes. That did nothing.

Quote from: LordKAT on June 14, 2014, 08:29:41 PM
I don't think it should be a set number of sessions. I don't think HRT should need any sessions. Surgery on the other hand should need a pass but not a set number. I had one where all we did is stare at each other for an hour, well 55 minutes. That did nothing.

For a lot of healthcare, protocols and set rules are established, especially in areas regarding surgery, and it is for the safety of both patients and doctors.

HRT in some respects, is not readily reversible.  For anything potentially irreversible, treating doctors want to be sure of their diagnosis so the desire for patients to go through some form of therapy prior is understandable.

Some might even say HRT without diagnosis would be the equivalent of someone fronting up to the ER with abdominal pain, requesting their appendix out and refusing to have the actual cause of their pain diagnosed.  I know that sounds like an extreme example, but the principle and philosophy applies.

I went private in the UK for a number of reasons. Primarily the wait times were just too long. I had more or less reached crisis point and going private gave me much quicker access to services. That being said, I had private therapy for 5 months before finding a private psych for an HRT prescription. I had an initial psych appointment were we discussed HRT, and on my second apt a month later had everything i needed for co-care with my GP and to start HRT. I'm glad I was still working with my therapist when the emotional shift of HRT kicked in.

My NHS invitation for my mental health screening, step 1, came after I had already started supervised HRT and was for an appointment still a few months off. Then would have been the GIC referral wait period, and at the time, that was understood to be 6-9 months after the screening. Without self-medding I would have had to wait another year for HRT during RLE (or such was my understanding but this has/had changed). Now with a 3 year wait for SRS up from 7-10 months on the NHS, (and some really bizarre referral rules that seem inconsistent with patient choice rules in the NHS that don't help,) the effective medical transition period is even longer.

I had a chance to talk to Dr. Lorimer at a trans health thing in London a while back and he was saying that cuts were basically slowing things down at the most heavily attended clinic in the NHS. GIC patients tend to rarely if ever skip their appointments and walk away. Numbers of stated regret out of CharX, allegedly attributed to Dr. Barrett were like 2 surgery regrets out of 6000 patients in his career there. Transition and SRS have far lower regret rates it would seem than any other surgery on the NHS.

Informed constent, as in sign on the legal waiver of liability, should be just that. It's the patients choice, and there are consequences for that choice. Anything else, allows for judgement. And who decides what the judgement should be, the prejudices that come with the judges, and etc until we're back to full on gatekeeping. Barrett allegedly said there should be more control for a process that's had 1/3000 or 0.03% reported regret rate. The notion of more gatekeeping is absurd to me.

Pragmatics aside, there are still a huge number of issues that I don't believe are purely the patients responsibility. Why are patients getting into emotional crisis over this? Why is this still so taboo? And why is this the patients responsibility to "fix" or justify this somehow? It feels assimilationist; prove you can be just like the cis folks and we'll let you play. Don't rock the boat. Ever. Finding a therapist, and a community that I could talk about these feelings (and others) was hugely important to my transition. If anything, the emotional side of things was helped with HRT and the world finally "feeling" the way I thought it should.

I guess what I'm slowly rambling towards, is that I had to own my emotional process and accept it for what it was, without blaming, finger pointing, or any sense of entitlement and just get on with it. Having uninhibited access to resources that could support that, is what got me through that, and affirmed me along the way. There were no tests, no milestones, just ownership of my own process. And granting people the dignity of owning their own transition is paramount in my opinion, and something that I've never seen discussed.

Just my experience and my opinions.

ymmv.

Quote from: peky on June 14, 2014, 05:52:39 PM
I think it should be a case-by-case approach, with the caveat that the initial triage should be conducted by the primary-care physician, provided that he/she has know the patient for a couple of years.

Why you may ask ? Well, in my opinion the primary care physician is the best person to vouch -or not- for the patient health status and cognizant abilities.

So, in this model, it would be up to the primary  care physician to recommend:

1) a quick interview with a physiologist for concurrence with a GO for SRS/HRT,

2) a 4 session with a psychiatrist to make sure patient is emotional and mentally stable before going with a GO for SRS/HRT, and

3) when patient is deemed to have deep undelaying psychiatric issues, the GO will be given after the patient is stabilized.

No. Just no.

First off, I don't have a set PCP. And in certain areas(like the Deep South) there's a non-negligible chance of a PCP country doctor reaction to discussing trans issues being along the lines of "LOL get out of my office pervert". Well maybe not stated openly, but I can think of a few that would flat out refuse referrals, so the result is wasting a couple years of your life.

Personally, the optimal choice is true informed consent. At the end of the day we're adults who own our bodies and need to be responsible for ourselves, and it's our responsibility to research and find the help and advice we need. Otherwise you run the risk of having androgynous/gender queer forced into stereotyped roles so they can access the support they need. So I'd vastly prefer to err on the side of looseness versu gate keeping.

One last point (until I think of another). Cindy, you used the term GID (gender identity disorder), which implies that being trans is itself an illness. Since DSM V went active it's GD (gender dysphoria) in which the depression and anxiety which often accompanies being transgendered is what needs to be treated. Sadly when I spoke to my doctor, who admitted that he had no experience, training or knowledge of this, he immediately started talking about antidepressants.

It elf seem that the county / state specific rules seem more powerful in determining how people have to proceed - including the education of "qualified doctors and therapists". Coupled with many peoples complex mental status it seems pretty difficult to make acceptable generalizations

And don't forget Susan's only picks out a handful of views - those without issues or curiousity seem to sail through without opinion and may well represent the larger spectrum of people transitioning.

Yes "regular therapy" sucks - cash mainly - but an experienced therapist can help massively. I had therapy for 3 years (with a year break) to sort out my feelings. But once decided they opened so many doors because the path was clear of obsticals. So I'm an outlier - very lucky - accepted by everyone - and determined. And I can't complain other than silly rules where Swiss Hospitals like you to be in their specific therapy program. But all rules are meant to be broken so I'm going private.

The topic makes me think of the two extremes. People who jump into quick decisions or decisions based on fantasies, and the other extreme of strict gate keeping where a person is over-supervised like a naive child. Either situation is bad. People make dumb decisions all of the time like marrying the wrong person, buying the wrong house, choosing the wrong career. On and on. Maybe the choices are not researched well. Sometimes the realities are way different from the expectations. It might be a career that requires 12 hours a day rather than 8 hours. It might be the way strangers look at you when you speak with them. There are a lot of unknowns. It's hard to tell exactly what a future life would be like. I think we should be allowed to make mistakes. I don't think it should be someone else's responsibility. I like being the captain of my own ship. I'd like passive advice rather than overbearing direction.

Quote from: ErinS on June 15, 2014, 10:03:08 AM
At the end of the day we're adults who own our bodies and need to be responsible for ourselves

Yes..... and no.

The trans world is full of "damaged goods", people who have developed conditions because of GD or come with conditions along with GD. There are also people in the general population with all sorts of conditions who are not capable of deciding what to pick from the supermarket shelf for dinner yet will walk into a police station and confess to crimes they never committed. It is so common that the police hold back details of crimes so they can sort out the "confessors" from those who are truly 'fessing up.

In a world like that you just cannot throw someone a piece of paper and ask them to sign it and say "Well everything is all right!!"

Quote from: Monkeymel on June 15, 2014, 10:44:46 AM
And don't forget Susan's only picks out a handful of views - those without issues or curiousity seem to sail through without opinion and may well represent the larger spectrum of people transitioning.

Indeed. I think that what you say is actually the case. It certainly mirrors what I have come across.

Quote from: Gina_Z on June 15, 2014, 10:55:13 AM
The topic makes me think of the two extremes. People who jump into quick decisions or decisions based on fantasies, and the other extreme of strict gate keeping where a person is over-supervised like a naive child. Either situation is bad. People make dumb decisions all of the time like marrying the wrong person, buying the wrong house, choosing the wrong career. On and on. Maybe the choices are not researched well. Sometimes the realities are way different from the expectations. It might be a career that requires 12 hours a day rather than 8 hours. It might be the way strangers look at you when you speak with them. There are a lot of unknowns. It's hard to tell exactly what a future life would be like. I think we should be allowed to make mistakes. I don't think it should be someone else's responsibility. I like being the captain of my own ship. I'd like passive advice rather than overbearing direction.

Same here.

Informed consent.... blah, blah, blah.....

This conversation is, so far, one sided. What about the doctors and medical people? Believe it or not, some of them have a conscience and actually care about their patients and want the best for them. Whether or not "informed consent" is the way to go, does anyone ever think about the medics?

They may just get you to sign on a piece of paper and it ma absolve them legally, but what about their conscience? What will happen to them if they see patients getting worse outcomes because they embarked on the wrong course of treatment?

And how robust is that legal waiver? If they simply consented to everything and hid behind a piece of paper, how long would it be until someone decided that the waiver was no protection? That factor "x" or circumstance "y" should have been picked up and treatment refused?

We, on the trans side, may want untrammalled access to whatever drugs we want, on demand with no restrictions, but what about the people who have to hand them out? And clean up the mess of ones gone wrong? They have to look at themselves in the mirror each morning. Do they deserve no consideration or protection?

Quote from: yvvrvt on June 15, 2014, 11:18:20 AM

The trans world is full of "damaged goods", people who have developed conditions because of GD or come with conditions along with GD. There are also people in the general population with all sorts of conditions who are not capable of deciding what to pick from the supermarket shelf for dinner yet will walk into a police station and confess to crimes they never committed. It is so common that the police hold back details of crimes so they can sort out the "confessors" from those who are truly 'fessing up.

In a world like that you just cannot throw someone a piece of paper and ask them to sign it and say "Well everything is all right!!"

My point as well and is the reason why it's incumbent on the provider to ascertain that the transition wannabe fully understands the ramifications before allowing them to sign an informed consent agreement. It needn't be a protracted or extremely expensive process driving them to take alternative routes and possibly harming themselves as a result.

Quote from: yvvrvt on June 15, 2014, 11:25:58 AM
Informed consent.... blah, blah, blah.....

This conversation is, so far, one sided. What about the doctors and medical people? Believe it or not, some of them have a conscience and actually care about their patients and want the best for them. Whether or not "informed consent" is the way to go, does anyone ever think about the medics?

They may just get you to sign on a piece of paper and it ma absolve them legally, but what about their conscience? What will happen to them if they see patients getting worse outcomes because they embarked on the wrong course of treatment?

And how robust is that legal waiver? If they simply consented to everything and hid behind a piece of paper, how long would it be until someone decided that the waiver was no protection? That factor "x" or circumstance "y" should have been picked up and treatment refused?

We, on the trans side, may want untrammalled access to whatever drugs we want, on demand with no restrictions, but what about the people who have to hand them out? And clean up the mess of ones gone wrong? They have to look at themselves in the mirror each morning. Do they deserve no consideration or protection?

Simple. They need to do what, in their personal opinion and experience, is right. There are reputable therapists and endos working in informed consent models, and some that aren't. I prefer IC, but understand some(both patients and treatment personnel) may need/want something different.

I find forcing everyone to use the same system as distasteful as forcing someone to bake a cake for individuals they don't agree with.

Quote from: yvvrvt on June 15, 2014, 11:18:20 AM

In a world like that you just cannot throw someone a piece of paper and ask them to sign it and say "Well everything is all right!!"

Well yes, actually you can. It comes down to fundamentally how you view the human experience, and whether or not people are responsible beings or wards of a nanny state.

I suspect our backgrounds and life experiences are so different we may never see eye to eye on this matter.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi103.photobucket.com%2Falbums%2Fm138%2FEringgirl9999%2FMobile%2520Uploads%2Fimage_zpsa00de3f1.jpg&hash=8c32cad7bbde2b470182c9e849fa293803d00251)

Quote from: kira21 ♡♡♡ on June 14, 2014, 12:55:13 PM
That's really good to hear that some people are getting more out of the process from the gic.  Unfortunately my experience with the gic (notts) is that they have not identified any councilling groups or anything like that for me.  They have not even mentioned it and I think that should be part of the process. 

I would still really like to talk about issues with a trained professional and I have not been offered the opportunity to do that with the gic and it should be a requirement.

I am not sure if you are blaming the person being treated when you say they find problems everywhere,  but if you are then I,  having spoken to the people I was referring to would not find that very fair,  but I could be misreading what you mean. 

I would not say the 'horror stories'  are not true (unless you think they are all lying - myself included.  I wouldn't really even describe mine as a horror story and if I had to do it again it would not put me off transition, it's just a disappointment and not how it should work. What I think it might be better to say is mixed bag.

That's the trouble with the nhs, its a medically focussed postcode lottery,
I have had a waiting period, of eight months,  but according to my letter, things will be moving very quickly come august. 1.5 years. seem like a long time, but ill be receiving 6 therapist appointments, once monthly (and if I can provide proof of name change ill have hormones the first visit, not having done this will result in having them the second, unless you wish to keep your name ), After that ill have to provide a proof of being active in my preferred roll. (voluntary work counts) this for a year and I can go in for srs. and as a further point, time scales can be reduced and it says, "depending on the level of transition the patient has already" accomplished. So what this looks like is, IF I have already been working and can provide proof of activity in the preferred roll, this time will be reduced from time needed to provide. and could result in srs eligibility after 6 months or even during that six months.

I don't think I would change anything, SO far. But im in leeds. But the processes for trans seem to be much the same as they are for everything ells. Excellent in some areas, ok in some, and completely disappointing In others.


BTW I'm certain we have informed consent in conjunction with practitioner evaluations. E.g The practitioner goes through everything with you, everything that will be on the letter, then askes you to read and sign, but no matter how many signatures you write they can still refuse if they have a recognised and/or valid reason why. And no matter how much they might like to, they still cant if you don't sign.

Yes I am a regretter but in favor of informed consent. I guess just make sure it is informed and that more emphasis is put on a. transition is not all or nothing and b. question and discussion why each individual procedure is desired and what are the potential outcomes. Ie why do you want SRS/HRT/FFS/beard removal/social transition... have you considered not doing it and doing ___? Do you have to have it now or can you wait? What if you don't like the results or you have complications? And so on.

EDIT: wanted to add many trans health "professionals" view in a cookie cutter sense.

I really have no problem with the process I went through. That included about 45 therapy sessions total so far. Honestly probably 30 of those were discussing exactly how to disclose to family and work on familial relationships, four were dedicated letters advocating my treatment, a few on course of treatment, a few on tangent therapy subjects(dealing with my ex) etc.

If one were to refine things down it could be done in a lot fewer sessions. All that work on disclosure didn't change a thing as far as I had guessed it would go.

A few scattered thoughts:

- Well, I've heard about the gatekeeping done in the UK and I agree with the person who said it was cruel. I know so many people who wait YEARS before even being able to start. That's just wrong, being made to suffer with dysphoria like that is really horrible.
- But I really don't know how I feel about informed consent. I've seen it happen so often where people are on HRT, experience a well-documented effect, and are shocked and have no idea why this is happening to them. So clearly, their consent was not all that well-informed.
- One big problem I see is the lack of knowledge on the part of therapists. It's not entirely their fault, as our knowledge is limited, but there are some people being approved for transition who later regret it and really never should have been given the OK. I see a lot of common denominators in the detransition stories popping up (won't get into them here), and those may need to start being addressed more closely in therapy.
- Then there are detransitioners who were really, absolutely certain they were trans and seemed to make a very well-informed, well thought out decision, and met all the criteria that we have established for GD. I don't see it often, but I have seen a few, enough to make me consider this. That's something that I can't really speak a lot on. Just noting that there are some detransitioners who have big, obvious signs that transition was wrong for them, and then others who seemed to be the ideal candidate for transition but it didn't work out.

Quote from: RoxanneN on June 15, 2014, 07:58:53 PM
Yes I am a regretter but in favor of informed consent. I guess just make sure it is informed and that more emphasis is put on a. transition is not all or nothing and b. question and discussion why each individual procedure is desired and what are the potential outcomes. Ie why do you want SRS/HRT/FFS/beard removal/social transition... have you considered not doing it and doing ___? Do you have to have it now or can you wait? What if you don't like the results or you have complications? And so on.

Agree.  While I am not a regretter I didn't end up where I expected.  My psychiatrist, my endo and my counsellors acted more as coaches - asking questions and providing information and advice and responding to my questions and concerns in an empathetic  but professional manner.

I started transitioning - completed FFS,  pretty much have cleared my face and have been on hrt for a couple of years - However I dialled the hrt back, when I became uncomfortable with the speed of change, and then had a breast reduction (they have since regrown) which allowed me the time I needed to understand that I was non binary and that being A was in fact the best outcome for me. 

I suspect that if I had taken the normal journey and fully transitioned that my transition would have been less successful than it has been.  The profession has therefore been enormously valuable to me and I certainly support informed consent IF the experts determine that the patient is dysphoric, is tg, does not suffer from any other underlying conditions and that the patient really does understand what they are consenting and committing to.

Aisla

Any man of legal age could walk into a body modification studio, have his penis split in half and then linked together with steel hoops....have his face tattooed with the image of his choosing and then be suspended from the ceiling by hooks through his skin. All he would need to do is sign a waver, and pay.
A woman can walk into a cosmetic surgery practice and have her breasts enlarged to the point where she can barely stand up straight, and her lips pumped with so much collagen that they look like car tires. Again....money and a signature.
But...because I am trans, I am not capable of making decisions about my own body? Why the double standard?

Quote from: TaoRaven on June 15, 2014, 11:51:37 PM
Any man of legal age could walk into a body modification studio, have his penis split in half and then linked together with steel hoops....have his face tattooed with the image of his choosing and then be suspended from the ceiling by hooks through his skin. All he would need to do is sign a waver, and pay.
A woman can walk into a cosmetic surgery practice and have her breasts enlarged to the point where she can barely stand up straight, and her lips pumped with so much collagen that they look like car tires. Again....money and a signature.
But...because I am trans, I am not capable of making decisions about my own body? Why the double standard?

TaoRaven

Good point.  My post reflected my experience and what I found worked best for me ... so maybe different strokes for different folks makes sense.  If it is our body and we are healthy and capable of making our own decisions then perhaps that is indeed enough.

Aisla

I agree with many here that having a team of professionals who act as specialized life-coaches is perhaps the best way to help us work through the peripheral issues that may be clouding the central GD issues.

There is a man who gives talks in Christian churches against all issues LGBT.  He detransitioned in the 1970's just before having SRS.  He had a long list of issues -- sexual abuse, alcohol and drug addiction, severe depression, among others.  He said he came to the conclusion that he was having such a rough time as a gay man that he'd probably be better off as a woman.  So he transitioned. 

It's no surprise to me that he came to regret his decision.  He had a ton of baggage, and predictably none of it was resolved by transition.  He also had none of the early childhood experiences that most of us had.  And from all I've read and heard he doesn't seem to have had gender or body dysphoria either.  This guy could have used some gate keeping.

Informed consent alone would have done him a disservice.  He's the exact kind of person that we don't want getting through the system.  He now travels all over the world warning people -- especially young people -- about the sinfulness of being transgender.  The problem is that I actually doubt he actually ever was transgender.  But he's regarded by these churches as an expert because of his experience.

I'm all for letting adults be adults.  But we as a group are also fighting public misperceptions, and involving trained professionals (not gate keeping) can only serve to help us and our cause.

I could be wrong, but my impression is that gate keeping happens most often in countries with socialized healthcare systems that will pay for transition after a long, if not archaic process.  But these are the same countries that also have gate keeping for normal procedures as well.  No?

Hospitals in the northern part of the US have a lot of "medical tourists" from Canada.  They come across the border for the quick access to the medical care they would otherwise have had to wait months or years to get for "free" in Canada.

Quote from: katiej on June 16, 2014, 12:51:24 AM
I could be wrong, but my impression is that gate keeping happens most often in countries with socialized healthcare systems that will pay for transition after a long, if not archaic process.  But these are the same countries that also have gate keeping for normal procedures as well.  No?

Hospitals in the northern part of the US have a lot of "medical tourists" from Canada.  They come across the border for the quick access to the medical care they would otherwise have had to wait months or years to get for "free" in Canada.

katiej

You may be right in some situations but in Australia we have both socialised and private healthcare and gatekeeping is nowhere near that which appears to be the case with the NHS in the UK .  In the UK I understand that there is also a quick, but more expensive private option.

Aisla

Quote from: katiej on June 16, 2014, 12:47:19 AM
Informed consent alone would have done him a disservice.  He's the exact kind of person that we don't want getting through the system.  He now travels all over the world warning people -- especially young people -- about the sinfulness of being transgender.  The problem is that I actually doubt he actually ever was transgender.  But he's regarded by these churches as an expert because of his experience.

I'm all for letting adults be adults.  But we as a group are also fighting public misperceptions, and involving trained professionals (not gate keeping) can only serve to help us and our cause.

This is a good point that I'm glad was brought up. It's something that worries me. My family is still not supportive - and likely never will be - due in part to stories like his.

It's worth remembering the huge selection bias (?) when looking at these issues.

Many successful transitioners disappear once finished.  They won't come here and tell us how great things worked out.  They won't be out and proud in society as trans.  They aren't showing up in the statistics, and are essentially invisible.

But many of the people who, for whatever reason, didn't succeed at transitioning are rather vocal about their experiences.  They can't always melt back into society, they sometimes stick out, a few might have some significant resentment at the system they think has let them down and cost them years of their lives, broken relationships, false promises and debt, and they want to tell the world about it.

The negative voices are far louder than they should be because the positive voices don't speak up.  By looking at this site and the internet as a whole, one would be forgiven for thinking that transition often leads to regret and problems (and life as a sex worker), whereas the reality is transition rarely leads to regret (or sex work).  It's all too easy to get sucked down the whirlpool of negativity.

Which brings us round to the point others have made about gatekeeping: there are two types, one negative (therapist wants more money, therapist likes wielding power, therapist is an idiot etc.), but one positive too (therapist genuinely wants to protect his or her patients because he or she mistakenly believes that lots of transitioners end up regretting their decisions.)  But it's still gatekeeping, and an overly-protective therapist who is holding back a client based upon distorted perceptions of the likelihood of "failure" is still damaging to the client's wellbeing.  While I think we need to separate the two and not throw out the good therapists with the bad, one thing is for certain - there's a huge need for programs to educate therapists in the realities of gender disorders.

We also can't push responsibility away from ourselves.  This is, ultimately, our own decision.  IC, gatekeeping, whatever.  We're the ones taking the pills and going under the knife.  Nobody ever forces us to do those things, so the buck stops with us.  What amazes me though is the fact that biologically, transition is always a slow process.  Hormones don't work overnight.  There is so much time for reflection, self-examination, figuring out whether this is the right path for us to take.  Regret will not just appear overnight - it'll creep in slowly and most people will see it a mile away and be able to take steps to avoid it (stopping HRT being the obvious choice.)  Post-op regret is surely such a small statistic because very few people will have lived in a bubble and really have had no idea that they were going too far by that point in their transitions.  When one goes under the knife, it's usually been preceded by a long course of HRT, living full-time in the chosen gender, etc.  There really shouldn't be many surprises left.

The regret problem could be solved by slowing the process down and making it more collaborative.  Hormones do that already, kinda.  The regret seems to arise from people either rushing through the process, or being stubborn and refusing to listen to outside voices who might be telling them things they don't want to hear.  I don't see much regret from anyone who takes transition one step at a time and in the care of suitable medical professionals.  That's not to say that such care is required by everyone transitioning (and there are some successful DIY transitioners or those who skip certain steps because they've researched their options carefully) - I'm only suggesting that if the goal is to minimize regret, then the standards for care already set out aren't particularly bad.

Quote from: __________ on June 16, 2014, 07:45:53 AM
The negative voices are far louder than they should be because the positive voices don't speak up.  By looking at this site and the internet as a whole, one would be forgiven for thinking that transition often leads to regret and problems (and life as a sex worker), whereas the reality is transition rarely leads to regret (or sex work).  It's all too easy to get sucked down the whirlpool of negativity.

That is why I largely avoid this place and make it difficult for myself to post here. If I stay too long the sheer quantity of negativity that is here gets to me. In recent times, I feel that Susans has got worse and worse. At one point I even asked them to block my IP (I have a static one) to stop me coming back because I get sucked in by wanting to help one person, then another and then it spirals out of control.

Quote from: __________ on June 16, 2014, 07:45:53 AMWe also can't push responsibility away from ourselves.  This is, ultimately, our own decision.  IC, gatekeeping, whatever.  We're the ones taking the pills and going under the knife.  Nobody ever forces us to do those things, so the buck stops with us.  What amazes me though is the fact that biologically, transition is always a slow process.  Hormones don't work overnight.  There is so much time for reflection, self-examination, figuring out whether this is the right path for us to take.

^^^^ This

Not a popular message around here though....

Dash, you're absolutely correct and the adverse selection of trans people is one thing I have been pointing out to my friends. The entire point is to pass unnoticed as a different gender than from birth, so by definition the ones people notice first are the trans people that aren't successful at it, and due to trans stigma the ones that can pass have a huge incentive to disappear. 

The problem with any filtering "standards of care" is if it gets too loose people who have no business transitioning will try it, too tight and authentic trans people are denied and put through unnecessary pain. It's a fine line to walk.

Quote from: ErinS on June 16, 2014, 08:26:20 AM
The problem with any filtering "standards of care" is if it gets too loose people who have no business transitioning will try it, too tight and authentic trans people are denied and put through unnecessary pain.

Isn't transitioning a legal right?

Who is to say who has any business transitioning and who doesn't?

Quote from: suzifrommd on June 16, 2014, 08:45:06 AM
Isn't transitioning a legal right?

Who is to say who has any business transitioning and who doesn't?

I think the example katiej spoke of is someone that probably didn't have any business transitioning, and would have benefitted from a little objective guidance.

Personally I'd like to remove all safety warnings, leave bins full of sharp and pointy objects on streetcorners and let Darwin work things out, alas I'm not Empress of the planet and others might not approve of my methods.

There's a difference between preventing someone from doing something, and letting them go ahead while pointing out they're being stupid. It's not my little red wagon to pull and as long as you keep it out of my yard I'm happy.

Quote from: __________ on June 16, 2014, 07:45:53 AM
We also can't push responsibility away from ourselves.  This is, ultimately, our own decision.  IC, gatekeeping, whatever.  We're the ones taking the pills and going under the knife.  Nobody ever forces us to do those things, so the buck stops with us.  What amazes me though is the fact that biologically, transition is always a slow process.  Hormones don't work overnight.  There is so much time for reflection, self-examination, figuring out whether this is the right path for us to take.  Regret will not just appear overnight - it'll creep in slowly and most people will see it a mile away and be able to take steps to avoid it (stopping HRT being the obvious choice.)  Post-op regret is surely such a small statistic because very few people will have lived in a bubble and really have had no idea that they were going too far by that point in their transitions.  When one goes under the knife, it's usually been preceded by a long course of HRT, living full-time in the chosen gender, etc.  There really shouldn't be many surprises left.

The regret problem could be solved by slowing the process down and making it more collaborative.  Hormones do that already, kinda.  The regret seems to arise from people either rushing through the process, or being stubborn and refusing to listen to outside voices who might be telling them things they don't want to hear.  I don't see much regret from anyone who takes transition one step at a time and in the care of suitable medical professionals.  That's not to say that such care is required by everyone transitioning (and there are some successful DIY transitioners or those who skip certain steps because they've researched their options carefully) - I'm only suggesting that if the goal is to minimize regret, then the standards for care already set out aren't particularly bad.

I honestly still fail to see what RLT has to do with SRS other than to put an artificial brake on rushing under the knife. Maybe it stops some people who otherwise shouldn't, but on the other hand maybe it leads to severe psychological damage to others who have had to put up with enough brown stuff in their lives and are about to break anyway. Regardless, who is to say that those who can pass/go stealth need SRS and those who can't or won't for whatever reason (established career, kids, etc) doesn't need SRS?

Again I will post that I live and work as a woman. In terms of finance I have been quite successful - I transitioned young and got a job where I am stealth as a woman and earn well above average income. I do admit there is privilege and luck here - not going to play it off as solely on my own merit. My social life could use a boost but ehhh... I have a wife (also trans) and her and my family are all supportive so could be worse too. That said I regret SRS. Bad. And I took my transition relatively slow. I was on HRT for almost 4 years before SRS. Still wanting to get a phalloplasty, it has been utterly crushing having 1 fail due to complications and the other aborted due to risk of the same complications (it was taken from the contralateral side where surprise surprise I have mirror anatomy). I am just desperately hoping for attempt #3 to be done very very soon. I need to contact one of the surgeons because they are overdue for informing me of a new date. It's a cancer that is killing my psychological health.

I think these last few entries show the difference between the USA and many other places. In the US there seems to be an attitude of "No one should stop anyone from doing anything and they if make the wrong choices then too *#!@~# bad".

On that basis.... post-op regret. Their fault. Moaners.....

Whatever happened to empathy?

[Edit: RoxanneN slipped a post in while I was typing mine]

Quote from: suzifrommd on June 16, 2014, 08:45:06 AM
Isn't transitioning a legal right?

Who is to say who has any business transitioning and who doesn't?

I don't think it is a legal right.  Not in the sense that we have a legal right, under all circumstances, to obtain whatever controlled substances we desire or force medical professionals to operate on us if we have enough cash to pay.  Perhaps in the sense that we are free to self-identify in whatever manner we choose, but without the consent (to some degree) of someone else who has the keys to the candy store and the knife drawer, we're pretty much powerless.  Nobody can (nor should) transition in a vacuum - that's how mistakes are made.

Quote from: __________ on June 16, 2014, 10:11:03 AM
I don't think it is a legal right.  Not in the sense that we have a legal right, under all circumstances, to obtain whatever controlled substances we desire or force medical professionals to operate on us if we have enough cash to pay.  Perhaps in the sense that we are free to self-identify in whatever manner we choose, but without the consent (to some degree) of someone else who has the keys to the candy store and the knife drawer, we're pretty much powerless.  Nobody can (nor should) transition in a vacuum - that's how mistakes are made.

Well, it's kind of silly that anything other than addictive drugs are illegal and even then one could make the argument that those should be legal too. That's a can of worms that I don't want to open up any further though, so I'll just bypass it and say that in most the Western World one can quite easily get HRT without a script. And in the US it's often actually cheaper to DIY even if you have insurance by the time you deal with copays and driving to the doctor.

The surgeon issue is a bit more complex. I must admit to having quite a bit of cognitive dissonance on this issue because I want to say it's foolish to force a surgeon to operate on someone no matter what as long as they come with cash or credit card in hand but on the other it's also foolish to deny a patient treatment because they can't find a surgeon willing to treat them or they have to travel out of the country to do so, etc...

Quote from: RoxanneN on June 16, 2014, 09:43:44 AMAgain I will post that I live and work as a woman. In terms of finance I have been quite successful - I transitioned young and got a job where I am stealth as a woman and earn well above average income. I do admit there is privilege and luck here - not going to play it off as solely on my own merit. My social life could use a boost but ehhh... I have a wife (also trans) and her and my family are all supportive so could be worse too. That said I regret SRS. Bad. And I took my transition relatively slow. I was on HRT for almost 4 years before SRS. Still wanting to get a phalloplasty, it has been utterly crushing having 1 fail due to complications and the other aborted due to risk of the same complications (it was taken from the contralateral side where surprise surprise I have mirror anatomy). I am just desperately hoping for attempt #3 to be done very very soon. I need to contact one of the surgeons because they are overdue for informing me of a new date. It's a cancer that is killing my psychological health.

I do feel where you're coming from, RoxanneN, but I don't think your outcome (slow transition, successfully stealth, now regretting SRS decision) is typical at all.  It seems highly unusual, in fact.  And in that sense, I think it's important to juxtapose it against the far higher number of transgirls who are extremely happy with similar outcomes.

I don't mean to diminish your story whatsoever - it is very important for us to hear it, and post-op regrets do exist no matter how long a time we spend weighing up the pros and cons beforehand.  Nobody has a crystal ball.  But just because so-called roadblocks didn't stop you making a mistake, it doesn't mean they are powerless to stop many other people from making the same mistake.

Again, I really do feel sorry that you've ended up somewhere you really didn't want to be.  If anything, your story is making a case for more roadblocks, not less.

Quote from: yvvrvt on June 16, 2014, 09:49:33 AM
I think these last few entries show the difference between the USA and many other places. In the US there seems to be an attitude of "No one should stop anyone from doing anything and they if make the wrong choices then too *#!@~# bad".

On that basis.... post-op regret. Their fault. Moaners.....

Whatever happened to empathy?

[Edit: RoxanneN slipped a post in while I was typing mine]

I have empathy. If anything, my coming to terms with the nature of myself has taught me compassion and made me a better person in almost all respects, even if my posts in this threads don't show it.

With that said, it has limits, and things derive their value partially from their scarcity. I have authentic compassion and empathy for people who make honest good faith mistakes and those trapped in circumstances beyond their control. If I have empathy for someone who is an adult and yet fails to do the slightest research or forethought on something that is probably the most important and pressing element of their life, then I insult those who actually deserve it.

A couple weeks ago I met a trans girl who was kicked out and disowned by her family, had a major and serious medical reaction to her orchi that destroyed her health, got fired for being trans and last I saw was being evicted and probably living on the streets right now. I have empathy for her. The person katiej talked about? The one making life harder for other trans people? Not so much.

Quote from: Aisla on June 15, 2014, 11:34:54 PM
Agree.  While I am not a regretter I didn't end up where I expected.  My psychiatrist, my endo and my counsellors acted more as coaches - asking questions and providing information and advice and responding to my questions and concerns in an empathetic  but professional manner.

I started transitioning - completed FFS,  pretty much have cleared my face and have been on hrt for a couple of years - However I dialled the hrt back, when I became uncomfortable with the speed of change, and then had a breast reduction (they have since regrown) which allowed me the time I needed to understand that I was non binary and that being A was in fact the best outcome for me. 

I suspect that if I had taken the normal journey and fully transitioned that my transition would have been less successful than it has been.  The profession has therefore been enormously valuable to me and I certainly support informed consent IF the experts determine that the patient is dysphoric, is tg, does not suffer from any other underlying conditions and that the patient really does understand what they are consenting and committing to.

Aisla

I agree with your personal decision to back off, I did the same and don't regret my decision because SRS and a full binary outcome is not the ultimate panacea for everyone. We may have taken the option to alter our trajectories somewhat and no doubt we will always be insulted by some who can't deal with our decisions, but then again they don't have to live in our skins.  :icon_ballbounce:

Quote from: __________ on June 16, 2014, 10:25:33 AM
I do feel where you're coming from, RoxanneN, but I don't think your outcome (slow transition, successfully stealth, now regretting SRS decision) is typical at all.  It seems highly unusual, in fact.  And in that sense, I think it's important to juxtapose it against the far higher number of transgirls who are extremely happy with similar outcomes.

I don't mean to diminish your story whatsoever - it is very important for us to hear it, and post-op regrets do exist no matter how long a time we spend weighing up the pros and cons beforehand.  Nobody has a crystal ball.  But just because so-called roadblocks didn't stop you making a mistake, it doesn't mean they are powerless to stop many other people from making the same mistake.

Again, I really do feel sorry that you've ended up somewhere you really didn't want to be.  If anything, your story is making a case for more roadblocks, not less.

Oh I agree it's atypical. However regarding roadblocks I disagree: I'd say SMARTER roadblocks are more important than MORE or HARSHER roadblocks though. The RLT again seems to foster the belief of: you are able to adapt to living in your target gender? Ok you get a vagina (or penis for trans men) - but if you can't? Nope you get nothing, you lose, good day. More of a view on the patients wishes, making sure the patient is informed, and a neutral voice that asks questions I think is more more beneficial IMHO. Would it have stopped me? Maybe. Would MORE roadblocks would have stopped me? Most likely not, unless said roadblock was only getting 1 procedure done at a time. In any case too late for me now, I just want the problem fixed.

Quote from: TaoRaven on June 15, 2014, 11:51:37 PM
Any man of legal age could walk into a body modification studio, have his penis split in half and then linked together with steel hoops....have his face tattooed with the image of his choosing and then be suspended from the ceiling by hooks through his skin. All he would need to do is sign a waver, and pay.
A woman can walk into a cosmetic surgery practice and have her breasts enlarged to the point where she can barely stand up straight, and her lips pumped with so much collagen that they look like car tires. Again....money and a signature.
But...because I am trans, I am not capable of making decisions about my own body? Why the double standard?

Exactly!  And like I said, where are the gatekeepers when she marries someone who is completely inappropriate and her life becomes a disaster? Right. She is allowed to make her own decisions. She should be allowed. 

Quote from: RoxanneN on June 16, 2014, 10:46:34 AM
Oh I agree it's atypical. However regarding roadblocks I disagree: I'd say SMARTER roadblocks are more important than MORE or HARSHER roadblocks though. The RLT again seems to foster the belief of: you are able to adapt to living in your target gender? Ok you get a vagina (or penis for trans men) - but if you can't? Nope you get nothing, you lose, good day. More of a view on the patients wishes, making sure the patient is informed, and a neutral voice that asks questions I think is more more beneficial IMHO. Would it have stopped me? Maybe. Would MORE roadblocks would have stopped me? Most likely not, unless said roadblock was only getting 1 procedure done at a time. In any case too late for me now, I just want the problem fixed.

I see where you're coming from, and I think we're on the same page.   :)  Smarter roadblocks would be much more preferable than just more roadblocks, particularly those which encourage patients to become more informed and certain of their choice in the interim.  Roadblocks with no purpose other than delay?  Yeah, a bad idea and would cause far more harm than good.

My transition will most likely end when hormones have done their thing.  Maybe an orchi, but full SRS is unlikely.  Provided I'm seen as female in 100% of situations where I have my clothes on, I'll be happy.  Luckily, I have a therapist who has helped reinforce that this is a perfectly acceptable outcome, because sometimes it's easy to fall into the trap of thinking that I'm not really trans unless I want to work towards SRS.

Quote from: __________ on June 16, 2014, 10:11:03 AM
I don't think it is a legal right.  Not in the sense that we have a legal right, under all circumstances, to obtain whatever controlled substances we desire or force medical professionals to operate on us if we have enough cash to pay. 

I specifically said TRANSITIONING is a legal right.

Transition doesn't imply HRT or surgery.

It is a legal right for a male bodied person to live as a female.

Do you disagree with that? That I legally should be prevented from living as a woman if I so choose? That I should need a doctor's permission for taking a woman's name and accepting female pronouns?

Time to exit, it's getting kind of shrill here. :icon_peace:

Quote from: Shantel on June 16, 2014, 11:10:00 AM
Time to exit, it's getting kind of shrill here. :icon_peace:

I agree...

Quote from: suzifrommd on June 16, 2014, 11:01:10 AM
I specifically said TRANSITIONING is a legal right.

Transition doesn't imply HRT or surgery.

It is a legal right for a male bodied person to live as a female.

Do you disagree with that? That I legally should be prevented from living as a woman if I so choose? That I should need a doctor's permission for taking a woman's name and accepting female pronouns?

Of course I don't disagree.  I'm not going to butt heads with you, suzifrommd.  Here's what I posted in full:

Quote from: __________ on June 16, 2014, 10:11:03 AM
I don't think it is a legal right.  Not in the sense that we have a legal right, under all circumstances, to obtain whatever controlled substances we desire or force medical professionals to operate on us if we have enough cash to pay.  Perhaps in the sense that we are free to self-identify in whatever manner we choose, but without the consent (to some degree) of someone else who has the keys to the candy store and the knife drawer, we're pretty much powerless.  Nobody can (nor should) transition in a vacuum - that's how mistakes are made.

You don't need a doctor's permission at all.  You're free to identify as you so choose - be that male, female, whatever.  I complete agree with you.

Now, whether it's a legal right or a human right is a whole different issue that I'm not going to get into in much depth.  The law defines what our legal rights are, whether we like it or not, and our own personal preferences have nothing to do with what our legal rights are and aren't.  And the law often lags behind in many areas - gender being one such area.  In some jurisdictions, you can identify as female all you like inside your own head, but in the eyes of the law you're still male and subject to various restrictions based upon that categorization until you've undergone certain medical steps.  In that sense, transition most certainly does imply some degree of medical intervention - from the perspective of our legal rights.

But in general, I fully agree with you.  In an ideal world, our legal rights to transition in any manner we choose would be absolute, but we're not living in that ideal world quite yet.  I wish we were.

I don't disagree at all that we'd all strongly prefer that the law stayed out of our private lives to the fullest extent possible.

Let's not argue over semantics.   :)

Quote from: __________ on June 16, 2014, 12:12:01 PM
Of course I don't disagree.  I'm not going to butt heads with you, suzifrommd.  Here's what I posted in full:

Sorry for the snippy post. I definitely overreaction. Your post(s) are well-thought-out and worth reading.

Too much T in my system, I guess (well, it's a good excuse, at least). Only two more days until it's gone for good...

Quote from: suzifrommd on June 16, 2014, 12:15:25 PM
Sorry for the snippy post. I definitely overreaction. Your post(s) are well-thought-out and worth reading.

Too much T in my system, I guess (well, it's a good excuse, at least). Only two more days until it's gone for good...

Nyet problemski, suzifrommd.  I didn't take it as snippy at all.

They should put anti-androgens in the water supply, kinda like they do with fluoride.  The world would be a much calmer place...

Quote from: Gina_Z on June 16, 2014, 10:54:31 AM
Exactly!  And like I said, where are the gatekeepers when she marries someone who is completely inappropriate and her life becomes a disaster? Right. She is allowed to make her own decisions. She should be allowed.

Indeed. It is vitally important that we be able to make our own decisions about our own bodies and lives.

And yes, sometimes we will make mistakes. And contrary to what some may have suggested, the attitude from the rest of us is very seldom "sucks for you", but one of support and empathy.

Quote from: TaoRaven on June 16, 2014, 01:07:19 PM
And yes, sometimes we will make mistakes. And contrary to what some may have suggested, the attitude from the rest of us is very seldom "sucks for you", but one of support and empathy.

This has changed a lot in recent years though. There is a lot more empathy now. Before it was definitely "sucks for you". Unfortunately so much of the idea of regret has been attached to those who have become very anti transgender after the fact, want surgery outlawed, etc.

I don't want that at all, I just want to be fixed :(

Quote from: __________ on June 16, 2014, 10:59:46 AM
I see where you're coming from, and I think we're on the same page.   :)  Smarter roadblocks would be much more preferable than just more roadblocks, particularly those which encourage patients to become more informed and certain of their choice in the interim.  Roadblocks with no purpose other than delay?  Yeah, a bad idea and would cause far more harm than good.

I went to Fenway in Boston for informed consent. The first appointment is medical. Bloodwork and a physical. The second appointment is a discussion with a therapist who spends about an hour with you. He asked questions that were deliberately phrased to weed out the people for whom informed consent may not be the wisest choice. He also asked me to list every effect testosterone could have on my body instead of telling me himself. At the end of the appointment, he informed me that he had to bring my answers before a medical board who would evaluate them and then decide if I needed a few more therapy appointments or to join a support group prior to starting testosterone. (I was approved.)

I'm not sure how it's handled at other informed consent clinics, but I felt that Fenway was as responsible as you can get. I can't imagine how someone could get past the therapy session and medical board without being deliberately manipulative if informed consent actually is not the right path for them.

Declan, that sounds like how IC should be done.  Emphasis on the "informed", and those who aren't are pointed in the direction of resources where the appropriate information can be found.  It seems IC is all too often treated with as little care as buying a used car - once you sign, it's yours.  It's not hard to check if someone is minimally informed before treatment.

Quote from: __________ on June 16, 2014, 10:59:46 AM
I see where you're coming from, and I think we're on the same page.   :)  Smarter roadblocks would be much more preferable than just more roadblocks, particularly those which encourage patients to become more informed and certain of their choice in the interim.  Roadblocks with no purpose other than delay?  Yeah, a bad idea and would cause far more harm than good.

That's the biggest reason I am so critical of my providers; it took 4 over four years for me to get HRT that could reasonable be expected to do anything and having to fight them at every appointment to get anywhere (I finally got it when, after that period, I switched to an Informed Consent clinic where a lot of information was given but no psych profile required - then again, I had already obtained my HRT letter years earlier, met the requirements to have my surgery letters written, etc., but the time I saw her so any such would have been unnecessary gatekeeping of me.) My first endo directly told me that she would not use any codes other than ones that were directly transition related for billing insurance and "they will most likely reject and you will have to pay out of pocket." When they didn't, at each subsequent appointment she mentioned her amazement at that fact...

QuoteMy transition will most likely end when hormones have done their thing.  Maybe an orchi, but full SRS is unlikely.  Provided I'm seen as female in 100% of situations where I have my clothes on, I'll be happy.  Luckily, I have a therapist who has helped reinforce that this is a perfectly acceptable outcome, because sometimes it's easy to fall into the trap of thinking that I'm not really trans unless I want to work towards SRS.

Alas, whenever we're subject to the approval of others, there's the chance for undue influence, and it happens very easily. If you had my therapist and doctors that would likely be seen as unacceptable and you would have been encouraged to either detransition or "complete" your transition by having SRS.

I've had a lot of people insist that my use of an informed consent HRT provider, at the point that I had already been through so much gatekeeping, was the only reason I regretted SRS, completely absolving the endless pressure to have SRS and requirement that I claim to want it or be denied access to any other parts of transition. Also that the same professionals strongly opposed any other procedures - I was told in fairly direct terms that having BA or FFS would not be viewed well.

I have regrets for SRS because it was a requirement to end the BS medical and metal health treatments. I walked into the OR in Montreal with doubts that I wouldn't voice because I knew Dr. Brassard would refuse if he knew and that, if that happened, I would face serious repercussions from my doctors and therapists when I returned home.

I don't have the patience for all that so many others are required to tolerate. About 20 years ago I decided that I wanted to transition so I went to a doctor and told him I wanted to go on estrogen. He was a GP and kind of a quack so knowing that up front and the fact that he was known for throwing pills at his patients on request, I decided to take advantage of him. Six months later I went to a well known trans woman doctor here in Seattle and showed her my pill bottle, she did the blood work and wrote me estrogen and spironolactone prescriptions. Four months later I became involved in VA, the endocrinologist who took me under his care, labs and hormones were free from that point on. Until then I was taking care of this privately as an out-of-pocket expense.

I got into a VA counseling program for PTSD and brought up my dysphoria issues during that time mentioned the fact that I was receiving HRT. I pre-wrote a consent letter that the counselor could use for her format which she copied with her official heading and title on it and she signed it for me I got another from the Seattle Trans doctor and yet a third from the VA endocrinologist and went to Portland Oregon's Providence Medical Center where I had an orchiectomy on my own dime, $700 back then in 2001. A year later I took copies of those same three letters along with the orchiectomy confirmation certificate and had my pre-SRS consultation with Dr. Bowers, we were all set to go and I decided against it at the last minute as it would have been the straw that broke the camel's back concerning my marriage which I valued beyond having a vagina.

The entire process was cut and dried, I set my cap to accomplish it and don't have any regrets because I am mentally competent and know my own mindset and have zero tolerance for manipulative controls from anyone. I feel bad for a lot of people that are sure of what they want to accomplish and yet have to deal with roadblocks along the way, but on the other hand I have to agree that some of it is necessary for many as there is a lot of mental health aberrations and delusional thinking in the TG community and unless they have done their homework and are damned sure about what they are doing it's best to suck it up and take the standard route.

To get my bariatric surgery I had to do the following:

See the surgeon
Get a tonne of labs drawn
EKG
Sleep study
Visit with psychiatrist
Three month diet

Weight loss surgery is not as life-altering as SRS/transitioning so, as a transwoman, a WLS patient, and a nurse, I think true informed consent and a waiting period to make really, truly, certain that this is what you want to do is not only an ethical issue but a requirment. The consequences of hasty action are too severe to do otherwise.

Quote from: Cindy on June 14, 2014, 02:52:15 AM
I certainly don't want to start and argument, more an intelligent discussion what is your opinion of  'quick' informed consent (basically HRT on demand no questions asked) 'true' informed consent, ( several visits to ensure you understand what you are doing) or extensive psychotherapy so that your problems are aired and discussed fully prior to HRT/surgery?

I come from this issue by comments I have had (not on this site) that quick IC is preferable - even if a number of people suffer or even die from making the wrong decision.

I find that unacceptable, I also BTW find gatekeeping, as generally understood by the community unacceptable. I prefer a model of community based therapy leading to psychiatric informed consent, followed by ongoing community therapy as needed.

Now a given is that everyone involved has to be properly trained and not the fly by night or Bible bashing medical community, but trained sympathetic therapists.

If you have detransitioned or have post op or even post HRT regret how would you like the system changed to a point that would have helped you?

Your thoughts?

Do Cis-women have to have "informed consent" and/or psychotherapy when they are seeking:
facial plastic surgery,
breast augmentation,
body countering
buttocks implants
buttocks lifts  ?

Having said that, it is my opinion the gate was open when HRT was prescribed ! It was at that time that the psychiatrist  had to diagnose the patient with a bona-fide case of GID AND make sure that the patient had no other SIGNIFICANT mental disorders. 

If a year later, and having completed at least 1 year of RLE, either your GP or your Endo should be able to give a letter recommending SRS, after all they (GP or Endo) are the ones who know you best.
One caveat, the Endo or GP should have option of seeking the concurrence of a psychologist or psychiatrist when in doubt.

Basically, it should be done in a case-by-case basis with some flexible and general guiding rules (NOT LAWS)

I can only voice my own experience in this matter, but here goes anyway:

I started HRT with no consent whatsoever. The whole reason I hadn't transitioned younger was because I didn't know about HRT. Before that, I had (wrongly) assumed that I'd never pass because my body was so big and so masculine, so I didn't even bother looking into it. Then in December of 2012, I discovered this site, and discovered Youtube transition timelines, and I was completely blown away, because there were people with way more masculine features than me who ended up looking completely gorgeous. I realized that the only reason I doubted that I wanted to be female was because I was scared of what other people would think of me, not because I was having any doubts about it myself. I quickly ran through the diagnostic criteria for someone to be trans, and when I fit every single one of them, I knew I couldn't wait any longer, I had to get on hormones NOW. Especially after reading all of the accounts of people who said that HRT was basically the best thing ever.

So, after doing research on what the correct dosages were, I started hormones on my own, via internet pharmacies. And within a week or so, I already knew that I could never go back.

About a month later, when I finally got on my company's health insurance policy, I went legit.

I had to start on informed consent because, again, I wasn't willing to wait. So my doctor wrote me a temporary 3-month prescription to bridge the gap, and told me that the next time I came, I'd have to bring a letter from a therapist stating that I "wasn't crazy."

I REALLY like the method that my therapist used. She said that if at any point I wanted a letter for anything, she'd write it, even if she disagreed with me. Because she believed that it wasn't her place to tell me what I could and couldn't do with my life, even if she thought I shoudn't. And I really like this method, because it made me free to be COMPLETELY honest in our therapy sessions, because I was never scared of having to be "trans enough" to get a diagnosis. Because even if she didn't think I was trans, if I really wanted the letter, she'd give it to me. So I didn't have to pretend, didn't have to hide anything, and so she was able to truly help me. She's been a friend and guide through this whole process rather than a gatekeeper standing in the way.


Now, while I'm really glad that I was able to get hormones so quickly, because I really was at that point where I wasn't willing to wait any longer, I don't recommend this method for anyone else. I went through all degrees of hell transition-wise because I was naive and uninformed at the beginning of it, so I was constantly caught up in my own head about what every single little emotion meant to my life as a whole, and I'm a chronic overthinker, ruminator, and panickier. Before I finally started going to therapy in mid-March, my moods were just all over the place, constantly going from elation to severe depression because I was trying to use how I felt as a measure of whether transition was right or not. It took that official diagnosis from my therapist (which I did get after 4 sessions,) before I finally started accepting myself as trans and calming down a bit. (And even after that, I still went through an absolute hell of emotions due to being fired from two jobs.)

So yeah... I like my therapist's method. Take the pressure off, be willing to write the letter no matter what because it's not their place to tell an adult what to do with their own life, but always be there as a guide. Because doing it completely on your own can be a pitfall of emotions and assumptions. So having an experienced professional there to guide you makes a big difference. I'm glad I went to my therapist instead of continuing to self-medicate. I put myself through a hell of uncertainty because of trying to do it on my own.



In regards to SRS, I don't know. I used to think that HRT was enough, but now I realize I do think that RLE might be a good thing. Because ever since going full-time, my genital dysphoria has greatly diminished. Pre-transition, I was obsessed with SRS, thinking of it as this ultimate validating female thing that was the one thing I couldn't have, and wanted more than anything. Now that I've been full-time for 4 months, it doesn't bother me as much. Now that I'm not looking for that silver bullet that would assert my femaleness once and for all anymore, it's not as pressing of a concern. I do think I still want to get it, but I'm glad that I wasn't able to just rush into it.

I don't think a set period, IE the "one year" requirement is necessary, I think it's more a matter of when someone reaches the point where they're settled enough transition-wise to be able to make an objective decision, which could be as short as a few weeks for the very self-assured, or years for those who are still having social doubts despite being full-time. IMO it should depend on whether the individual is mentally ready for it or not, time notwithstanding.



Again, I don't know how this plays into the overall picture, though. This is just my experience. I know there's a lot of self-medicators who are probably completely emotionally stable and don't see therapy as anything other than getting in the way, a lot of people over on Eunuch.org with severe genital dysphoria who wish they could have orchiectomy/penectomy/SRS available without the need to be female socially, and likewise there's people who probably don't do their research as thoroughly as I did, who might need that gatekeeping to make sure they're not rushing into a decision that they'll regret, or using the wrong dosages/prescriptions and doing harm to themselves. I don't know.

True informed consent worked pretty much perfectly for me, so I'm all for that.

The approach is Spain, at least in Madrid (health is a regional competence, not a national one), is extremely sensible.

You may ask your health service doctor to refer you to a specialist gender identity unit and they cannot refuse you the referral.  The gender unit where I go has an endocrinologist, sociologist and psyschologst as the core team.  It is slow however, but it does not look like they reasonably deny people hormone treatment at the very least.  They do require a psychologist's report identifying dysphoria, accompanied at least by a passive statement that the psychologst does not perceive a problem if the patient wishes to begin hormone treatment.

You can argue that the psychologist is acting as a gatekeeper but I don't believe this is the case practically speaking.  I think there is a very strong case for a mental health professional to be able to make a decent assessment of the person's psychological state prior to a patient hurtling down a path before they have clarity and insight into the true motivations behind their dysphoria. 

Quote from: Julia-Madrid on August 08, 2014, 06:12:00 PM
The approach is Spain, at least in Madrid (health is a regional competence, not a national one), is extremely sensible.

You may ask your health service doctor to refer you to a specialist gender identity unit and they cannot refuse you the referral.  The gender unit where I go has an endocrinologist, sociologist and psyschologst as the core team.  It is slow however, but it does not look like they reasonably deny people hormone treatment at the very least.  They do require a psychologist's report identifying dysphoria, accompanied at least by a passive statement that the psychologst does not perceive a problem if the patient wishes to begin hormone treatment.

You can argue that the psychologist is acting as a gatekeeper but I don't believe this is the case practically speaking.  I think there is a very strong case for a mental health professional to be able to make a decent assessment of the person's psychological state prior to a patient hurtling down a path before they have clarity and insight into the true motivations behind their dysphoria.

Very sensible indeed (Los Gatos saben)

My only concern is when people just can't wait for HRT and either self medicate or do informed consent and then post here wondering why this medication is doing this or if this symptom is normal or not. That tells me the person was not making an Informed Consent decision.  :)

well, I can only speak for my self and don't know if it applies to others. I've had pretty much extensive therapy all my life, I happen to love ripping apart my mind and putting it back together again through the psychoanalytic  process. I admit to being a little weird. I hadn't been in therapy for 20 years. I lost my job and had other major psychological problems do to my dysphoria. I had been seeing a social worker trained in psychology 2 weeks prior to losing my job because I couldn't handle the loneliness anymore, then I lost my job and ended up in the hospital psyche ward. The overnight psychiatrist ask me what was wrong and I told her I wanted to be a woman. They first tried to give me antipsychotic drugs , but that didn't last long because I have a condition where my mind physically reacts negatively to anti depressants and antipsychotics . the antipsychotics have to do with dopamine suppression and chemically my brain can't function properly when the dopamine is block by the  mechanism. The thing was that I was mentally triggered by the side effect of breast growth from both the antidepressants and the antipsychotics. I've wanted female hormones since high school but had no idea of the process to get them. I lived in the denial by trying to be the male I was supposed to be , so I refused to admit I was transgender , but back to the therapy, I decided I needed to do estrogen to save my life and wrote a short letter to the medical team involved in my treatment they agreed and my life began. So yes its up to you.

I'd like to add to this discussion. While I've not had SRS I have started to plan for it.

I believe strongly in informed consent, and to me informed consent means that someone is informed of the consequences of their decisions, and is capable of giving consent. "Capable" being judged by a psychiatrist since that is their area of expertise (i.e. they are not nuts). By that standard WPATH is not informed consent, since there is a requirement for 1 year RLE, and I disagree with WPATH. I also I believe it does not include a diagnosis of being transgender or not. I have no opinion on people who are not mentally capable giving consent, or children, as I don't know anything about that.

When I started HRT I did it DIY, and I partly did so as I didn't want a diagnosis of a psychiatric disorder (it was more that 5 years ago). There's some definite downsides to that. So I informed myself, visited a therapist over the course of a year, then started HRT. My only regret is not starting sooner.

Due to not transitioning I've been suffering depression and started seeing a psychiatrist. I was very conflicted at first, as I really needed help, and there's no point in seeking help if I don't tell the truth, but telling the truth carries the risk that should I decide to proceed with SRS then the truth might prevent me getting it. Fortunately as with HRT, and as others have mentioned, there are ways around that, so I went ahead anyway, and its been very helpful. I wouldn't be concerned visiting medical professionals if it really were informed consent and that would be a great relief. If there was serious gatekeeping then more than likely I'd end up convincing myself and the psychiatrist that I needed SRS just due the the pressure on me not to mess it up. Fortunately Sydney is blessed for transgender people and I feel I'm getting the help I really need.

I also believe that everything around this subject is very biased by moral/cultural influences. Life is full of risk, but there's something special about this subject where people feel the need to tell others what to do. Driving kills vast number of people, as does smoking and alcohol, but there's not too much preaching about that. We accept some personal limitations for the benefit of society since these do affect other people but generally get a license, or be of the required age and you're fine. Others have mentioned cosmetic surgery - good point. Yes there's a risk of making a mistake. That pretty much applies to everything in life. I regret more that anything not realizing I'm trans when I was young. What an idiot. With gate keeping there's a risk of others making mistakes for you - I'm not ok with that at all. Increasing or decreasing the amount of gate keeping is not going to change the fact that people will get hurt, only change the number who get hurt on either side of it. I think the total good/bad either way is a matter if speculation, but if I'm going to get hurt I want it to be my choice.

Finally, things seem to be getting better for transgender issues these days, and I'd rather have a system put in place while we can that allows no personal biases by medical practitioners to refuse treatment. Its a slippery slope once that happens, and if things turn against transgender people in the future then that will cause no end of trouble. I understand that getting an abortion in some parts of America is practically impossible, even though its legal. I'd hate to see all our hard won freedoms going the same way.

Hi.

I consider getting into the US informed consent branch. Because I am now in a gatekeeping system, the topic of regret on the 'quick' informed consent may come up during my talk with therapist, so I wanted to have some data. I found this topic looking for actual data on regret ratio at the 'quick' informed consent. But there seems to be no data on regret rate, is there any?

Re gatekeeping, so far here one should have reckoned with 6-8 months waiting before first ever appointment for mandatory psychological 'diagnostic'. Then one month or so between each session. Uncertain how many sessions. No private health care option available. Absolute control over hormone access. I read that in UK waiting time can be 3 years before first appointment, but I also heard they have private health care that provides an alternative.

After tasting the above, I can only vote up for the 'quick' informed consent. I would also vote up for having an exam where people can prove they are well aware of what HRT is about and what one should know. Specifically designed to shake wish of those who would rather wait a little longer or see a therapist. That is the way to return the key in people's hands.

Still, are there any actual data on the regret ratio for the 'quick' informed consent option? I would be happy to consume them.

Anybody know the detransition numbers for when somebody went with the complete GRS

Quote from: TinaVane on February 15, 2016, 08:16:23 PM
Anybody know the detransition numbers for when somebody went with the complete GRS

I bet its a while lot less than the suicide rate of those who get that far.

Quote from: AnonyMs on February 15, 2016, 10:37:39 PM
I bet its a while lot less than the suicide rate of those who get that far.

Hhhmmmm which is not that high when they get the complete surgery right ?


Sent from my iPhone using Tapatalk

Yea, my question goes for those who returned from / regretted HRT. That is where the gatekeeping is. It is a little hard to use existence of 'quick' informed consent pro-actively in a discussion without knowing numbers. Not knowing numbers only allows defensive position in case the other side mentions it.

Well me myself I been off and on on hrt but only because of financial reasons


Sent from my iPhone using Tapatalk

I went off HRT two times.  Once I was DIY and after gaining a bunch of weight and watching my blood pressure rise I started getting chest pains.  So I stopped because I thought I was killing myself.  The second time I was DIY and it was too expensive with my situation at the time.  Both times I regretted that I had to stop.  This time I'm doing it right with DRs and with insurance and not regretting anything.  Plus my health has improved this time.

FWIW.  I'm not against informed consent but for me counseling was very valuable in putting my mind at ease.


Sapere Aude

I'm in the UK and I think things here are done the right way. Essentially there's private care in which you can do informed consent and the national healthcare service NHS deals with it a
In a little bit more of a gate keeping way, but it really doesn't feel that way, you can tell that due to the fact they are public healthcare, they have to filter out people who might regret transitioning. I can understand why. They have a limited amount of funds and they are trying to do the most they can rather than just handing out HRT to every person who comes in asking for it. I was told by my consultant how it's quite often the least patient of people the ones who end up not transitioning in the end or were just exploring.yet they demand HRT on the first visit. Which I consider wouldn't onky be financially irresponsible but medically irresponsible also. If people want instant HRT then they can have private care and they can pretty much have their HRT within a few weeks max.

Mod Edit:Removed TOS 9

Quote from: calicarly on February 16, 2016, 03:05:02 PM
I'm in the UK and I think things here are done the right way. Essentially there's private care in which you can do informed consent and the national healthcare service NHS deals with it a
In a little bit more of a gate keeping way, but it really doesn't feel that way, you can tell that due to the fact they are public healthcare, they have to filter out people who might regret transitioning. I can understand why. They have a limited amount of funds and they are trying to do the most they can rather than just handing out HRT to every person who comes in asking for it. I was told by my consultant how it's quite often the least patient of people the ones who end up not transitioning in the end or were just exploring.yet they demand HRT on the first visit. Which I consider wouldn't onky be financially irresponsible but medically irresponsible also. If people want instant HRT then they can have private care and they can pretty much have their HRT within a few weeks max.

Well the nhs is very variable depending on who you get to see and the times are crazy,  so the variability of feedback on the nhs will be massive.

Also,  many cannot afford private healthcare and really shouldn't have to when they have already been paying for the nhs their whole working lives.

For me,  I had transition including all docs months before nhs even got to my first appointment and they still made me follow the same process as a questioner because 'everyone gets the same process here'  meaning that I would have had to wait about 2 years until HRT if I hadn't have taken matters into my own hands. By having a gatekeep ing service with such long delays,  the nhs is creating a self medding problem. 

Quote from: kira21 ♡♡♡ on February 16, 2016, 03:22:15 PM
Well the nhs is very variable depending on who you get to see and the times are crazy,  so the variability of feedback on the nhs will be massive.

Also,  many cannot afford private healthcare and really shouldn't have to when they have already been paying for the nhs their whole working lives.

For me,  I had transition including all docs months before nhs even got to my first appointment and they still made me follow the same process as a questioner because 'everyone gets the same process here'  meaning that I would have had to wait about 2 years until HRT if I hadn't have taken matters into my own hands. By having a gatekeep ing service with such long delays,  the nhs is creating a self medding problem. 

We agree Kira, but this post is about post op regret and de transitioning. Sadly it is the people who are in that group , and the people who seek help but never transition at all that there's all this gate keeping, which makes things tougher for us transgender patients. I'm an ideal world we should be the priority and who get helped through. But there's a much bigger number of people that have to be filtered out than people realize. And so GIC's focus on preventing them from transitioning to keep them safe instead of us as I mentioned above. I guess I came across sort of wrong. I mean that in regards of regret and de transition the UK is a place where they prevent this as much as possible but at least people can access private care in the mean time. I know how lengthy waiting times are and they have been getting worse by the day. Same in Canada. GIC's are getting fuller and waiting times for surgery longer and longer. if only there was a quick an easy test to prove ->-bleeped-<- like a neurological test. Then we wouldn't have to suffer as much. But there isn't. Even then, you think we are hard done to here in the UK? I would love for you to meet all the trans women in many states in the US (where I'm originally from) who's insurances refuse to cover anything trans related, insurances they also pay with their hard work. I just don't believe in all this self deprecating attitude here in the UK. It's not great, but I've never known of a genuine patient being outright denied service like in many other countries.

Quote from: calicarly on February 16, 2016, 06:13:12 PM
We agree Kira, but this post is about post op regret and de transitioning. Sadly it is the people who are in that group , and the people who seek help but never transition at all that there's all this gate keeping, which makes things tougher for us transgender patients.

I'll preface this with saying I'm not living in the UK, and not had any trans experience there either. I'm in Sydney and I have money, so my personal experience is quite different.

My impression of the UK is that there's a lot of gatekeeping. As one example I keep reading how people are being asked to do RLE before HRT even though its not supposed to happen anymore, and even that's only recent change.

I have the feeling that your consultant is justifying a poor system with poor arguments. Just because they have Dr in front of their name doesn't make them worthy of respect.

If you make the system difficult enough you would no doubt reduce the incidence of post-op regret. Only the most determined would ever get though it. You mighty lose a few to suicide along the way of course, but that's nobodies fault is it. On the other hand if you make it really easy their would probably be more regret, but less suicide, and and who's going to get the credit for each of those?

And suicide is only part of it, because even if you survive its still mental torture and all the damage that goes along with it.

Informed consent is about making sure people are mentally capable of making their own choices, and allowing them them do so. You can argue that the NHS is paying so they need to get value for money, but I given how the entire thing works I don't think that's what its about. Its all about authority and control.

I can't imagine how non-binary people get though it all. And for someone like myself I'd have big problems as I need HRT and likely SRS and I've no intention of social transition anytime soon.

Oh,  I am not self depreciating...  I know,  certainly in terms of SRS we have it better than most places, just by virtue of it not being immediately out of pocket.

In terms of HRT I would say we are a bit behind.  We need informed consent. I think if our system had that at the beginning and we can get waiting list down some it would be great.  It doesn't mean I won't point out how we can do it better though and our system does have flaws, like the choice between waiting years or self medding that a lot of people face.

Quote from: AnonyMs on February 16, 2016, 07:37:32 PM
I'll preface this with saying I'm not living in the UK, and not had any trans experience there either. I'm in Sydney and I have money, so my personal experience is quite different.

My impression of the UK is that there's a lot of gatekeeping. As one example I keep reading how people are being asked to do RLE before HRT even though its not supposed to happen anymore, and even that's only recent change.

I have the feeling that your consultant is justifying a poor system with poor arguments. Just because they have Dr in front of their name doesn't make them worthy of respect.

If you make the system difficult enough you would no doubt reduce the incidence of post-op regret. Only the most determined would ever get though it. You mighty lose a few to suicide along the way of course, but that's nobodies fault is it. On the other hand if you make it really easy their would probably be more regret, but less suicide, and and who's going to get the credit for each of those?

And suicide is only part of it, because even if you survive its still mental torture and all the damage that goes along with it.

Informed consent is about making sure people are mentally capable of making their own choices, and allowing them them do so. You can argue that the NHS is paying so they need to get value for money, but I given how the entire thing works I don't think that's what its about. Its all about authority and control.

I can't imagine how non-binary people get though it all. And for someone like myself I'd have big problems as I need HRT and likely SRS and I've no intention of social transition anytime soon.

This is what I mean about the culture of complaining, you've read from the British patients about the gatekeeping at GIC's, obviously you never heard that informed consent does exist in this country too. Just not at the GIC. And even if you pay to see the specialist for a fee privately, the meds can be prescribed by your GP, so you do not take the hit of paying for them like in other countries. They call it shared care here. It is only the GIC who requires RLE for further treatment.

Trying to find out why having money would make your experience quite different than UK patients? Being cared for by the NHS doesn't mean they don't have money Hun.they all have their own individual circumstances.

I am always trying to better understand non binary people and I will say I understand most non binary have unique ways of expression which makes transition difficult in some ways particularly with it not being the norm, so respects to you on that and wishing you a smooth ride. :)

Quote from: kira21 ♡♡♡ on February 17, 2016, 01:17:22 AM
Oh,  I am not self depreciating...  I know,  certainly in terms of SRS we have it better than most places, just by virtue of it not being immediately out of pocket.

In terms of HRT I would say we are a bit behind.  We need informed consent. I think if our system had that at the beginning and we can get waiting list down some it would be great.  It doesn't mean I won't point out how we can do it better though and our system does have flaws, like the choice between waiting years or self medding that a lot of people face.

Amen girl I pretty much agree on everything you've said here, room for improvement there's tons, I just feel like I can "almost" see why  informed consent is only available privately for now here, how does a public healthcare system make sure informed consent can  be given yet not too quick that it becomes a financial/medical irresponsibility particularly when being looked at with a magnifying glass by the media which often sensationalises trans medical spending. I so agree tho, there has got to be a way. I'm sure there must be other countries with public healthcare and they might be using informed consent within it and if that is the case then we ded are behind in that regard and they could mimic that from elsewhere.