We're having a discussion about who qualifies for HRT through informed consent in another thread, and I thought the discussion would be more visible with its own topic. The site Wiki describes informed consent (https://www.susans.org/wiki/Informed_consent) as:
Informed consent is the concept that a patient who is informed of all the issues of a certain medical treatment may undergo that treatment on their own responsibility. It usually requires the signing of a special release form.
Of particular interest is informed consent in regard to transsexual hormone therapy and surgery. Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for those who have been diagnosed with Gender Identity Disorder / Dysphoria or as a Transsexual.
For reference, here are the Standards Of Care:
https://www.susans.org/wiki/Standards_of_Care_for_Gender_Identity_Disorders
The question is: Can a crossdresser with no GD receive Informed consent HRT?
Hugs, Devlyn
One would think so...but it would depend on the Dr doing the prescription.
Some Dr s are very conservative in their practice, others are more accommodating.
Imho
I'm reading it as needing a GD diagnosis to receive the treatment. I honestly don't feel that way. I know what to say to a doctor to get them, a couple ways, in fact. It wouldn't be right, though.
Thanks for replying, Beth! :)
Hugs, Devlyn
I had occasion to spend time with a trio of crossdressers one evening. One of the three had been on HRT for several years, with no intention of transitioning.
They were getting their prescriptions from the same clinic that I was using. Informed consent is alive and well in Seattle.
Quote from: Devlyn Marie on March 07, 2015, 03:59:06 PM
I'm reading it as needing a GD diagnosis to receive the treatment. I honestly don't feel that way. I know what to say to a doctor to get them, a couple ways, in fact. It wouldn't be right, though.
Thanks for replying, Beth! :)
Hugs, Devlyn
And it can be read as "if GD is diagnosed, then SOP is to prescribe HRT, but if GD is not present or diagnosed, then informed consent may be used to get HRT"...because if one is diagnosed, then IC is not relevant. When would IC be relevant? When GD is not present or diagnosed.
Some might argue that this is stretching the rules a bit, but others would diagree. And as Megan notes, Seattle (and other places, I'm sure) is kind of tolerant towards TG people. Texas might not be...but if one can find a dr to prescribe...WOOT!
Random Googling turns up a multitude of pages...
Informed consent apparently does not require a diagnosis:
Quote
Source (http://www.templehealth.org/ICTOOLKIT/html/ictoolkitpage5.html)
[table 1] The Basic Features of Everyday Informed Consent
The physician (not a delegated representative) should disclose and discuss:
The diagnosis, if known
The nature and purpose of a proposed treatment or procedure
The risks and benefits of proposed treatment or procedures
Alternatives (regardless of costs or extent covered by insurance)
The risks and benefits of alternatives
The risks and benefits of not receiving treatments or undergoing procedures
Source: AMA 1998
I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.
Hugs, Devlyn
Quote from: Devlyn Marie on March 07, 2015, 04:25:29 PM
I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.
Hugs, Devlyn
Without asking people such intimate questions, we'll never know.
Here's a quote from
ibid:
Quote...As soon as I mentioned the purpose of my visit was to obtain a referral for their informed consent program,
she ((the doctor)) asked what my goals were in seeking HRT (since they do provide hormones to people who aren't necessarily trans, are
genderfluid, etc) and we started to discuss my options. She gave me a rundown of what I should and should not expect
from hormone therapy, what the potential side effects were and finally the pros and cons of pills vs. injections vs. patches...
Quote from: Devlyn Marie on March 07, 2015, 04:25:29 PM
I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.
Hugs, Devlyn
Devlyn, I never had any serious amount of physical dysphoria - it amounted to little more than the thought 'Hey, this isn't quite right.' What messed with my head is that I knew who I was and how I was perceived by the world didn't match. Apparently this is a form of dysphoria and was more than enough for my therapist to agree that hormones would be a good thing for me. So I'm one that didn't fit the standard narrative at all..
This is really an interesting debate and I'm going to respond 'without' reading any others, then I'll see where my views fall. My very first reaction was to think 'no', for this reason, hrt is risky enough for those who's options are nill to none. So the idea for a person who likes to crossdress (now I'll find out soon enough if wrong) and this activity being part time, once hrt begins it is not like a person can just travel backwards and forwards when one choose's.
OK, then I began to think, well it's their body, how can anyone dictate what they choose to do if the risks are known.
I do not know if this could be legally prevented because this is 'not' under the heading of anything that I'm aware of. Now to see what others think :-\. Dani
I admire your style, and your courage!
Quote from: Devlyn Marie on March 07, 2015, 02:04:27 PM
Informed consent is the concept that a patient who is informed of all the issues of a certain medical treatment may undergo that treatment on their own responsibility. It usually requires the signing of a special release form.
Hugs, Devlyn
Hmmmm, this may be an even more interesting side question: If the above is indeed true and Informed Consent has been signed, placed within the patient file and hrt treatment has begun, then the doctor for whatever reason (say using old reference materiel) decides to backtrack on medication, can the patient not only refuse but would not the doctor be obligated to continue the treatment unchanged?
I think informed consent conveys to the patient the risks they may be taking by taking the medication? Crap, I don't know. I did everything by Harry Benjamin's book. I didn't want to mess up my life any more than it was already messed up. I don't know that I'd have come along any faster. And since most of the money was in the Electrolysis, a few doctor visits didn't amount to much.
Cindi
This seems like a tricky question to me. I don't think IC would necessarily mean you can just walk in and expect treatment. The IC seems to me to mostly do away with the requirements of the SoC beyond merely being diagnosed as having GD. The issue with SoC isn't that it requires a GD diagnosis, it's that it requires other irrelevant or unsafe hoops be jumped through.
As to whether HRT would be appropriate without a GD diagnosis, I'm of two minds. I feel like a doctor should be prescribing medications to treat a condition, so I can see the argument that if you don't have a medical diagnosis, it would be unethical to provide medical treatment. But on the other hand, and I lean toward this being more sensible, there are lots of medical treatments that are considered both ethical and elective.
Actually, the more I think about it, I think the latter makes the most sense, if only for the practical reason that some people will self-medicate if they can't go through proper channels. Better to let them through the proper channels than to "protect" them into unsupervised medical treatments.
The question is: Can a crossdresser with no GD receive Informed consent HRT? |
I think it would depend on the doctor and location in the country. I go to Mazzoni in Philadelphia PA and they do informed consent. They are my primary care and they see a lot of trans and gender fluid patients. The only way to know is to find a trans clinic and try.
I think the doctors at my primary care want a ideal patient that is stable, clean and sober, smoke free, knows the risks and effects of HRT and accept the risks and effects. My primary care wants to do the best thing for the patient and not gate keep.
I think if a person identifies they would feel better with breasts, soft skin and curves with HRT then they must not feel as good about their body as it is presently. A feeling of unwell about one's body is GD, to me, and a valid reason for HRT.
It would depend on the doctor, but the entire reason the informed consent model exists is to not require a GD diagnosis. Here is the policy of the closest informed consent clinic to me on who can get an hrt prescription:
QuoteThe person has the cognitive ability to make an independent decision. In other words, that person understands the potential risks and benefits of the choice and is able to anticipate how that choice may impact them now and in the future
and
The person has the information needed to make an informed decision.
So at this one if you say you need them and you prove that you understand the risks and have a realistic expectations of the benefits, you will get a prescription of your medical screening allows it. I know clinics like that are few and far between but they do exist.
Quote from: Devlyn Marie on March 07, 2015, 03:59:06 PM
I'm reading it as needing a GD diagnosis to receive the treatment. I honestly don't feel that way. I know what to say to a doctor to get them, a couple ways, in fact. It wouldn't be right, though.
Quote from: Devlyn Marie on March 07, 2015, 04:25:29 PM
I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.
I don't think that lying and integrity and right and wrong are such simple things.
I think lying to the doctor to get HRT if that's the only way is right. In a moral sense its right. I'm not sure how it happened, but I have a strict moral code and I absolutely hate doing the wrong thing. I've given a lot of thought to right and wrong over the years. Its a big deal for me, so much so that I've talked to my psych about it. I flat out lied to someone 20 years ago, and another one last year, and it bugs me still. I've lied very few times in my adult life, because usually it is wrong, but in this case its not. I refuse to do some things that others will, and on this post I'm probably out of step with everyone else.
Lying to save someone's life is usually not wrong, which I think shows that lying in itself is not wrong, it's the why and consequences that are important. In this case the doctor is in the wrong, and correcting that is right.
I'm starting to think this is why I've not felt shame at being transgender, because I truly don't recognize it as wrong. Its also my view on crossdressing.
I don't see lying as anything to do with informed content. The important part of that is that you are informed and have the mental capacity to consent. Anything outside of that is a moral judgement.
Quote from: Devlyn Marie on March 07, 2015, 02:04:27 PM
We're having a discussion about who qualifies for HRT through informed consent in another thread, and I thought the discussion would be more visible with its own topic. The site Wiki describes informed consent as:
Informed consent is the concept that a patient who is informed of all the issues of a certain medical treatment may undergo that treatment on their own responsibility. It usually requires the signing of a special release form.
Of particular interest is informed consent in regard to transsexual hormone therapy and surgery. Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for those who have been diagnosed with Gender Identity Disorder / Dysphoria or as a Transsexual.
For reference, here are the Standards Of Care:
https://www.susans.org/wiki/Informed_consenthttps://www.susans.org/wiki/Standards_of_Care_for_Gender_Identity_Disorders
The question is: Can a crossdresser with no GD receive Informed consent HRT?
Hugs, Devlyn
Yes, a crossdresser can obtain hormones through informed consent -- and honestly, even through WPATH. I'll be completely 100% honest; WPATH nowadays isn't so stringent, and even I -- someone who has pretty much been a victim of the dreaded a-word-a-philia for as long as I can remember -- obtained hormones through WPATH in less than a month. As far as informed consent goes, I decided to go that route after facing problems with my initial treating doctor, and it was pretty much like a PEZ dispenser, in reference to someone's analogy several months ago on my informed consent forum. "Informed consent clinics aren't PEZ dispensers..." Yeah, they sort of are, and this is a good thing for those who
know that transitioning would make them happier. There was a definite sexual component to my transition, as seems to be the case with some crossdressers, yet I can tell you that I've been happier than I ever imagined since commencing my transition 5 months ago. Just my two cents. :P
Informed consent is really all over the map.
Some will require you to talk to their counselor.
Some will just ask you to sign acknowledging the risks.
Some will want to find out of you have a therapist and if not you see their counselor.
Generally it is accepted that people with GD and who wish to medically transition can get hormones. Crossdressers are discouraged for some reason, but I'm sure some do anyway.
However I am genuinely curious and I mean no disrespect. If CDers are not transitionining then why do they need the hormones?
Just my 5 cents. When I got my independent second review for surgery I was given a copy of the letter and I quote: Cindy displays no evidence of gender dysphoria, she requires surgery for gender incongruence, she desires her body to match her mental gender.
In talking to several psychiatrists their opinion has been that if a client requires HRT to allow him or her to live a normal happy normal life, that they understand the risks involved and that they have no untreated comorbidities then HRT is justified.
After all there is no restriction on a surgeon providing a BA to a male presenting person if the surgeon deems that such surgery is ethical.
There is a possible down side to this. The effects of HRT can be profound both physically and mentally. A person who is primarily interested in crossdressing may find that it becomes socially and physically difficult to function as male due to such changes. I think this is a very personal issue that needs to be addressed by the individual.
It also needs to be rembered, that HRT tends to be far more effective than herbals in feminization, so if you have had positive results from herbals you may respond dramatically to HRT. This may not be what you desire.
As ever YMMV.
Quote from: Cindy on March 08, 2015, 01:06:16 AM
There is a possible down side to this. The effects of HRT can be profound both physically and mentally. A person who is primarily interested in crossdressing may find that it becomes socially and physically difficult to function as male due to such changes. I think this is a very personal issue that needs to be addressed by the individual.
It also needs to be rembered, that HRT tends to be far more effective than herbals in feminization, so if you have had positive results from herbals you may respond dramatically to HRT. This may not be what you desire.
That would be the informed side of things, but reading it I wonder how any doctors actually understand it themselves? From everything I've read on this site, there must be many cases where the doctors themselves are not capable of doing anything but signing paperwork and handing out prescriptions.
There's quite a good piece on informed consent at Wikipedia
http://en.wikipedia.org/wiki/Informed_consent
Informed consent...a doctor may prescribe under these conditions but not full dosages. Sending said person to endo or other to fill the blanks,who then sending through to psychiatrist or said therapist. I didn't think many docs handled it all themselves?
Let me know if I'm mislead?informed consent may start the process but not give full outcome.
I would say yes but it would be difficult as HRT is a serious matter not something you can reverse easily if you have a change of mind/heart. With that in mind some places may have steps you need to take first to make sure you know what you are getting into and how it will affect you in both mind and body
Quote from: ImagineKate on March 08, 2015, 12:35:35 AM
Informed consent is really all over the map.
Some will require you to talk to their counselor.
Some will just ask you to sign acknowledging the risks.
Some will want to find out of you have a therapist and if not you see their counselor.
Generally it is accepted that people with GD and who wish to medically transition can get hormones. Crossdressers are discouraged for some reason, but I'm sure some do anyway.
However I am genuinely curious and I mean no disrespect. If CDers are not transitionining then why do they need the hormones?
In my case, I'm not looking for them. I'm getting the desired results from herbal supplements. Every time I mention that, I'm shouted down and told to see a doctor or go informed consent. As far as I can tell, the rules require a GD diagnosis, then the informed consent rules kick in. That's why I'm asking if people recieved their hormones by presenting as a crossdresser, or if they gave the Standard Trans Narrative, even though they're a crossdresser. I could game the system easily, but I won't.
Hugs, Devlyn
Quote from: Devlyn Marie on March 08, 2015, 08:13:08 AM
In my case, I'm not looking for them. I'm getting the desired results from herbal supplements. Every time I mention that, I'm shouted down and told to see a doctor or go informed consent.
OK... a number of things
1) Herbals do not work
I took these for about a year before starting "proper" HRT. Results varied depending on the herbal but one of them was particularly effective and produced
breast tissue and
softer skin. When I had my pre-HRT assessment by my endo I showed him the herbals, told him the dosage and his opinion of them was that they clearly worked as I had some feminisation. Some herbals obviously do work.
I mentioned to him that I took herbals because I believed that they were like low-dose HRT and I wanted to start the process without having the harmful effects of getting normal HRT wrong on self-medding. He commented that there could be anything in the capsules, that no estrogen showed up in my blood work, but my SHBG was through the roof. Once on HRT it came back down. My liver enzymes were high as well, but not dangerous. My testosterone was low but still in the male range, just near the bottom.
2) Dosages
The elephant in the room around Susan's Place and yet it really matters in this discussion and here is why. To get the herbals to work for me I took what I thought was a moderate dosage but my blood work said otherwise. There are no standard medical blood tests for phytoestrogens so nobody can measure them. You can have other things such as liver, kidney, SHBG, prolactin, etc measured and hopefully they would give warning of something going wrong before it is too late.
The real danger that I was unaware of was my dropping testosterone. Men's health is very sensitive to low testosterone and it is the trigger for a number of conditions and phytoestrogens are not estrogens so they are not really a good replacement for the missing T. In normal transition the drop in T is made up by the huge increase in E, but this switch has one important effect which is often overlooked - your metabolism slows by 25% or so to female levels. Your energy and strength both lessen, naps, break and snoozes become more important and if you continue your standard intake of food your weight will shoot up rapidly.
3) HRT Dosages
I know a couple of crossdressers self-medding on Progynova (Estradiol Valerate). They are cross-dressers, happily male for 95% of the time but they want some effects from HRT. One of them wants a "fleshier" chest so that it can be plumped up into what he called "Saturday night boobs". The other wanted better skin as it is known that HRT often improves skin tone. So they take very low dosages because they are both married and do not want to feminise. One wife knows about the CDing the other's wife does not.
The problem is that the HRT is having no effect. The dosages are so low that the effects of estrogen are less than minimal. One of them had a blood test and it showed normal male levels of T and E so he upped the dosage and had a retest. Still no effect. Levels of T were medium-high. If he goes much further he will be on a transitioning dose and he does not want that. The boobs have not arrived nor has the skin tone improved. Nor is it likely to.
4) Success?
What happens if you succeed and get feminisation or at least effects from the pills? The answer for some seems to be that the desire to cross dress goes away. Also what about the other effects? If T lowers then your metabolism slows, erections usually decrease or become softer (explain that to the wife) and you may get
sore boobs which will cause many day-to-day problems - lifting things like most guys do is out, contact sports are out and the 'jiggling' can be very unpleasant necessitating a bra. What about the mood swings as puberty #2 hits? What if you start thinking like a girl and all your male friends become incomprehensible to you, their motivations, likes and goals alien to your new viewpoint?
5) Informed consent? Maybe not...
I cannot see why a cross-dresser would want to do this except for the wrong reasons. HRT is a very blunt instrument, very much something which is all or nothing. Generally speaking, cross-dressers identify as male and most of the time have a male identity. HRT is the start of a journey into the female world. There is a big, big difference between being female for the mirror and being out as female and the danger is that if HRT succeeds it may very well out you. Then what?
Most doctors know little about male to female HRT, that is why we see specialists but I am willing to guess that even fewer medical people understand the full effects of HRT and how it radically alters your
mind. Most of their guidance will be for standard dosages and not "oddly low" dosages so how can they talk to you about this in sufficient depth to really make the consent
informed? All they can really do is throw a few generalities in your direction and get you to sign a legal waiver saying you understand what they failed to inform you of because they do not really understand it either.
Over to you Devlyn ....
Devlyn will strongly disagree that herbals do not work... I think they do just not as effective
Quote from: Devlyn Marie on March 08, 2015, 08:13:08 AM
In my case, I'm not looking for them. I'm getting the desired results from herbal supplements. Every time I mention that, I'm shouted down and told to see a doctor or go informed consent. As far as I can tell, the rules require a GD diagnosis, then the informed consent rules kick in. That's why I'm asking if people recieved their hormones by presenting as a crossdresser, or if they gave the Standard Trans Narrative, even though they're a crossdresser. I could game the system easily, but I won't.
Hugs, Devlyn
Ok no not really.
There is no diagnosis required.
If you want hormones and accept the risks that you will grow breasts and may get DVT or breast cancer and sign the dotted line you get it. They will have a counselor talk to you here to make sure you are ready. I don't think they question your intentions.
I have no formal diagnosis. I'm kind of scared to get one actually until I'm ready for SRS.
I showed up dressed as a girl. I do that to every one of my appointments because I want to be taken seriously.
In my case they know and work with my therapist. But in other places like callen-Lorde they have their own.
My previous primary doc told me he'd prescribe HRT if I really wanted if it would make me feel better. He's not even a trans care doc.
It can be done and the rules aren't as strict as they seem. Nor should they be.
Maybe i'm just naive o ignorant myself but why would someone get hormones if they only want to crossdress? I mean it's not like they shouldn't be able to do so, if they feel like they wan to transition, I don't know uhm.
Kate, I think mgbdyy is stating what I've found, that herbals can provide curves, softer skin, and breast growth. Welcome to Susan's Place by the way, mgbdyy! Although it sounds like you've done some lurking! :laugh: I should state that the supplement I use is regulated, but is not a prescription drug.
mgbdyy, I'm curious why you feel a crossdresser's reasons for wanting feminization are wrong? This is how I live now, I'm out to the people I work and do business with as a transgender person, a crossdresser. I'm not worried about the implications of anyone seeing changes, they're going through it with me.
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fi1279.photobucket.com%2Falbums%2Fy537%2FDevlynMarie%2F20141230_115316_zps8678c394.jpg&hash=8a6144580dfa586e272657166a1c8fc6481ec6df)
Hugs, Devlyn
Quote from: Serena ♡ on March 08, 2015, 09:37:58 AM
Maybe i'm just naive o ignorant myself but why would someone get hormones if they only want to crossdress? I mean it's not like they shouldn't be able to do so, if they feel like they wan to transition, I don't know uhm.
Because we all walk our own path. I'm part male, part female, I'm sure of it. We don't have to choose male or female, there's middle ground.
Hugs, Devlyn
Quote from: Devlyn Marie on March 08, 2015, 09:49:19 AM
Kate, I think mgbdyy is stating what I've found, that herbals can provide curves, softer skin, and breast growth. Welcome to Susan's Place by the way, mgbdyy! Although it sounds like you've done some lurking!
I have been here on and off over the years. These days I just make an account if I want to pop in for a bit, but I have no time to be drawn into some of the factions or arguments that sometimes erupt so I rarely stay long.
Quote from: Devlyn Marie on March 08, 2015, 09:49:19 AM
mgbdyy, I'm curious why you feel a crossdresser's reasons for wanting feminization are wrong?
I do not think it is
wrong I just cannot understand why a crossdresser, a member of a group that usually has no
dysphoria would seek a treatment for dysphoria. I suspect that many have specific objectives such as boobage (always seems to be popular when I talk to CDs) and many would like one or two specific aspects, but as I said HRT is rather a blunt weapon, very much all or nothing rather than pick'n'choose.
Quote from: Devlyn Marie on March 08, 2015, 09:49:19 AMThis is how I live now, I'm out to the people I work and do business with as a transgender person, a crossdresser. I'm not worried about the implications of anyone seeing changes, they're going through it with me.
You seem to be something of an exception for CDs. Most of the ones I encounter are very, very firmly in the closet except at special locations or events. Based on this, I am going to go out on a limb here and ask the following: If you feel you have no dysphoria, why do you dislike your male body enough to want to feminise it?
Quote from: Devlyn Marie on March 08, 2015, 09:54:07 AM
Because we all walk our own path. I'm part male, part female, I'm sure of it. We don't have to choose male or female, there's middle ground.
Hugs, Devlyn
yeah but when I think about crossdressers I usually think about people who identifies as men and want to dress up only occasionally, and then maybe take off and live as guys too, and hrt effects can be irreversible, why would someone to through, maybe it's not really that they are just crossdressers, but I guess labels identifying just sucks.
Quote from: mgbdyy on March 08, 2015, 10:03:06 AM
I have been here on and off over the years. These days I just make an account if I want to pop in for a bit, but I have no time to be drawn into some of the factions or arguments that sometimes erupt so I rarely stay long.
I do not think it is wrong I just cannot understand why a crossdresser, a member of a group that usually has no dysphoria would seek a treatment for dysphoria. I suspect that many have specific objectives such as boobage (always seems to be popular when I talk to CDs) and many would like one or two specific aspects, but as I said HRT is rather a blunt weapon, very much all or nothing rather than pick'n'choose.
You seem to be something of an exception for CDs. Most of the ones I encounter are very, very firmly in the closet except at special locations or events. Based on this, I am going to go out on a limb here and ask the following: If you feel you have no dysphoria, why do you dislike your male body enough to want to feminise it?
The boobage was the driving force, because I thought it would look right on me, and it does. I had a muscleless, hairless frame that looked like a flat chested woman with a penis. Now I look like a woman with modest breasts and a penis, and I like it. I know some people see me as a man with boobs, that's just a matter of which direction you're looking at it from. The fact is, I'm a hybrid, an exotic. I know that language won't sit well with everyone, but it's how I see myself.
So to reset, does the hybrid get HRT because they want it?
Hugs, Devlyn
Quote from: ImagineKate on March 08, 2015, 09:35:38 AM
Ok no not really.
There is no diagnosis required.
If you want hormones and accept the risks that you will grow breasts and may get DVT or breast cancer and sign the dotted line you get it. They will have a counselor talk to you here to make sure you are ready. I don't think they question your intentions.
I have no formal diagnosis. I'm kind of scared to get one actually until I'm ready for SRS.
I showed up dressed as a girl. I do that to every one of my appointments because I want to be taken seriously.
In my case they know and work with my therapist. But in other places like callen-Lorde they have their own.
My previous primary doc told me he'd prescribe HRT if I really wanted if it would make me feel better. He's not even a trans care doc.
It can be done and the rules aren't as strict as they seem. Nor should they be.
Kate, you say no diagnosis required, but may I ask what you said when you scheduled your first appointment? Did you indicate you were transsexual? Self diagnosis is indicated as proper by the SOC, iirc, so that would be informed consent
after a diagnosis? Sorry if I'm reading anything wrong, or reading anything in.
Hugs, Devlyn
Quote from: Devlyn Marie on March 08, 2015, 11:19:23 AM
Kate, you say no diagnosis required, but may I ask what you said when you scheduled your first appointment? Did you indicate you were transsexual? Self diagnosis is indicated as proper by the SOC, iirc, so that would be informed consent after a diagnosis? Sorry if I'm reading anything wrong, or reading anything in.
Hugs, Devlyn
I told them I was transgender. I did not use the word transsexual. Transgender is a word you use to describe yourself as a cross dresser as well, right?
However in my case I told them about my therapist and they do work with her.
Quote from: Cindy on March 08, 2015, 01:06:16 AM
There is a possible down side to this. The effects of HRT can be profound both physically and mentally. A person who is primarily interested in crossdressing may find that it becomes socially and physically difficult to function as male due to such changes. I think this is a very personal issue that needs to be addressed by the individual.
Well, fortunately HRT effects are reversible for a long time, so it's a case where a trial period can be used with relatively little risk (beyond those inherent in the treatment itself).
Quote from: Devlyn Marie on March 08, 2015, 11:19:23 AM
Kate, you say no diagnosis required, but may I ask what you said when you scheduled your first appointment? Did you indicate you were transsexual? Self diagnosis is indicated as proper by the SOC, iirc, so that would be informed consent after a diagnosis? Sorry if I'm reading anything wrong, or reading anything in.
I'm not Kate, obviously, but my endo was not at all interested in any formal diagnosis. She asked some questions about my history and support/safety, would have asked if I was seeing a therapist if I hadn't volunteered that, then explained her strategy and wrote the prescription. No signatures or formal risk counseling were involved. She marked a diagnosis code of transsexual on my paperwork, but that was entirely based on my showing up and telling her that I was transgender, together with a consistent story I guess.
Edit: grammar
Quote from: Devlyn Marie on March 08, 2015, 11:09:49 AM
The boobage was the driving force, because I thought it would look right on me, and it does.
I had a muscleless, hairless frame that looked like a flat chested woman with a penis. Now I look like a woman with modest breasts and a penis, and I like it.
OK, let me suggest the following - that you do in fact have Gender Dysphoria because:
(a) you were not happy with your body as it was,
(b) you are prepared to publicly display a female identity,
(c) the condition has persisted for a significant time and
(d) you are comfortable with a female self image
These are not traits held by "normal" members of the male population. The fact that you are uncomfortable enough with your body to make these changes suggests to me that you should feel no reserve in claiming you have GD and asking for HRT. It is true that switching publicly between male/female roles might be viewed as dual-role transvestism but that is also in "The Manual" under Gender Dysphoria.
Quote from: Devlyn Marie on March 08, 2015, 11:09:49 AM
So to reset, does the hybrid get HRT because they want it?
You are already on HRT. The question is do you want the more effective, medically monitored variety or the stuff you are on now?
Thoughts?
Well if your truly informed and consent why not??? GD or not call it whatever you want people should be free to do as they wish with their bodies... CD or whatever in my mind "men" and chemical castration and estrogen dont really go together :laugh:
Quote from: ImagineKate on March 08, 2015, 11:27:52 AM
I told them I was transgender. I did not use the word transsexual. Transgender is a word you use to describe yourself as a cross dresser as well, right?
However in my case I told them about my therapist and they do work with her.
Yup, it's the umbrella term. I don't doubt anybody's word, I'm just trying to verify how people presented (medically, not dress) to their providers.
Hugs, Devlyn
Quote from: mgbdyy on March 08, 2015, 11:43:44 AM
OK, let me suggest the following - that you do in fact have Gender Dysphoria because:
(a) you were not happy with your body as it was,
(b) you are prepared to publicly display a female identity,
(c) the condition has persisted for a significant time and
(d) you are comfortable with a female self image
These are not traits held by "normal" members of the male population. The fact that you are uncomfortable enough with your body to make these changes suggests to me that you should feel no reserve in claiming you have GD and asking for HRT. It is true that switching publicly between male/female roles might be viewed as dual-role transvestism but that is also in "The Manual" under Gender Dysphoria.
Checkmate! :laugh:
You are already on HRT. The question is do you want the more effective, medically monitored variety or the stuff you are on now?
Thoughts?
My thoughts are "I wonder why I don't see wanting the changes as being unhappy?" You've given me some food for thought. You make very convincing points.
Hugs, Devlyn
Quote from: Devlyn Marie on March 08, 2015, 11:55:10 AM
My thoughts are "I wonder why I don't see wanting the changes as being unhappy?"
If the changes are taking you in a direction that makes you more comfortable with yourself then why should you be unhappy about making them? If they make you more comfortable then they are to be desired, not reviled.
From my own perspective, the changes have settled me tremendously. I did not loathe my body although I was increasingly unhappy with my general appearance and I never really slept properly at night because my mind would obsessively spin around thinking about how I was wrongly formed, but I got through life until I had to change. The choices were gone and I had to do it. So I did it. When I got to the shrink he took about 10 minutes to tell me I had GD in spades because only someone with GD would do what I had done. I had been "RLE" for 14 months before I saw the shrink. "Normal Blokes" just do not do that. The fact that I was prepared to make these drastic changes to my life was diagnosis enough. One other point he added was that asking if you had GD was practically a diagnosis in itself. People, in general, simply never question their gender.
I tried being a crossdresser and failed. It took me about 10 minutes mixing with crossdressers to figure that I was very different from them. I had no desire to hide. I was not shy about being me. I had no worries about presenting publicly and I
hated, absolutely
loathed breast forms and hip/bum pads because they were so false. Not genuine. Not me. I had no shame about being female because that was me, that was who I was deep inside.
I would have preferred to be a crossdresser. To have the ability to chose when to deal with dysphoria by dressing, to not have to tell everyone, to not lose friends and family.... oh yes, CDing would have been a much, much better option for me. But it was not to be. It was never the clothes that were wrong, it was me that had to change and so I have done that.
Quote from: Devlyn Marie on March 08, 2015, 11:55:10 AM
You've given me some food for thought. You make very convincing points.
Why not go see a counsellor? Spend a little bit of money and go for one session and goes as Devlyn, make the appointment as Devlyn and make your first question "Do I have Gender Dysphoria?" and see where it goes.
Just a thought, but "happy" and "unhappy" are not a binary decision. Right now I am happy about some things, unhappy about others. And I'm different degrees of "happy" about each thing.
So, and this is what I think happened to me because I never felt entirely unhappy due to GD, I think I knew that I was not as happy as I could be due to my birth sex and body. On balance, I could quite often honestly describe myself as happy, and I was lukewarm about my body parts. I just knew that it would be a big improvement if I could exchange them for a better fitting set.
Just because we're transgender (or the appropriate term for each of us) doesn't mean that facet of our identity has to be the dominant one. We are complicated beings, every one of us.
Quote from: Devlyn Marie on March 08, 2015, 11:45:14 AM
Yup, it's the umbrella term. I don't doubt anybody's word, I'm just trying to verify how people presented (medically, not dress) to their providers.
Hugs, Devlyn
Devlyn, I first showed up to the endo in guy mode, told him I didn't need anything more than a low dose at that time and that I was not intending to transition fully nor socially any time soon. I simply said that I wanted to see if it was really for me, and if it wasn't, then I was going right off of it.
I went full time two months later.
This has been an interesting topic, because I thought I understood what crossdressing is, but now I don't know. Specially, Devlyn what you describe sounds like gender queer, wanting to be in between. I do say this in positive way, as I really would like to have a better understanding.
As for informed consent. I think willingness to change ones body shows some degree of GD. But even ignoring that, I would think a doctor would be willing to prescribe HRT, under the "least harm", or "do no harm" motto. I think doctors would rather prescribe someone HRT, which is a very regulated and understood, as apposed to doing nothing and a person takes herbs to get the result, which is not regulated and is not well understood.
Quote from: Jill F on March 08, 2015, 05:32:54 PM
Devlyn, I first showed up to the endo in guy mode, told him I didn't need anything more than a low dose at that time and that I was not intending to transition fully nor socially any time soon. I simply said that I wanted to see if it was really for me, and if it wasn't, then I was going right off of it.
I went full time two months later.
This is why I keep asking the question, though. How did you end up in an endo's office? You don't see one because you have a splinter. At some point before the prescription did your gender come up?
Hugs, Devlyn
Quote from: jessical on March 08, 2015, 06:39:58 PM
This has been an interesting topic, because I thought I understood what crossdressing is, but now I don't know. Specially, Devlyn what you describe sounds like gender queer, wanting to be in between. I do say this in positive way, as I really would like to have a better understanding.
As for informed consent. I think willingness to change ones body shows some degree of GD. But even ignoring that, I would think a doctor would be willing to prescribe HRT, under the "least harm", or "do no harm" motto. I think doctors would rather prescribe someone HRT, which is a very regulated and understood, as apposed to doing nothing and a person takes herbs to get the result, which is not regulated and is not well understood.
Bad day to ask me about better understanding, I'm getting quite confused about myself today! :laugh: Hang around and we'll see if we can figure me out!
Hugs, Devlyn
Quote from: Devlyn Marie on March 08, 2015, 06:49:58 PM
This is why I keep asking the question, though. How did you end up in an endo's office? You don't see one because you have a splinter. At some point before the prescription did your gender come up?
Hugs, Devlyn
Hi Devlyn,
I thought I was a crossdresser... until I started to consider why I was interested in crossdressing, my identity is female and she wanted to just dress pretty.
I ended up at my Endocrinologist's office after I'd had about 6 weeks of therapy and my therapist gave me the verbal approval for HRT. I booked the appointment, and about two weeks before asked about what I'd need to bring with me to start hormone therapy. I went to the appointment in a cute polka-dot dress, light makeup, nude hose, and black flats, presenting as a middle aged woman in a dress. We had a good discussion, I mentioned my history with both crossdressing, I mentioned that there were touch points where I would mention to my mother that I was sure I wasn't male, then there was my 12yo boob growth spurt and how I was disappointed when it stopped, and more. In the end she agreed, I had GD, and at my next consultation I'll be starting HRT.
I'd highly recommend you at least work with you Primary Care Physician, to see where your levels are. Bio-identical's do work, but there's a danger in the fact you don't really know how much you're getting, and its efficacy at regulating your levels. That's what you should really consider: get the proper tests, and if you stick with BI get some follow up tests to see how it's affecting you levels. This is really important that you have a good handle on it, because this can be serious if it's not right. I imagine that's the motive for not mentioning dosing in the TOS, because the levels are different because we are each unique. It probably doesn't matter that you're not exactly femm, or want to move a little closer to being femm, the end result is that you have the desire to change your hormone balance to the point you're getting feminine secondary sexual characteristics.
-Alana
Quote from: Devlyn Marie on March 08, 2015, 06:49:58 PM
This is why I keep asking the question, though. How did you end up in an endo's office? You don't see one because you have a splinter. At some point before the prescription did your gender come up?
Hugs, Devlyn
My therapist told me to call him and mention that I am her patient.
Quote from: Devlyn Marie on March 08, 2015, 11:09:49 AM
The boobage was the driving force, because I thought it would look right on me, and it does. I had a muscleless, hairless frame that looked like a flat chested woman with a penis. Now I look like a woman with modest breasts and a penis, and I like it. I know some people see me as a man with boobs, that's just a matter of which direction you're looking at it from. The fact is, I'm a hybrid, an exotic. I know that language won't sit well with everyone, but it's how I see myself.
So to reset, does the hybrid get HRT because they want it?
Hugs, Devlyn
An "exotic hybrid"... I think you should be in charge of all labeling in the TG spectrum. Sounds awesome.
To answer your question, I don't see why not. I think the gut instinct is to say "no" because most people don't see non-transitioning cross-dressers as "hybrids". If they met more people like you and not based it on media stereotypes, I think it would change the landscape of it. And you are right, there is a sort of exotic romanticism in what you are doing. You are probably a walking prototype for the future of humanity for all we know.
Quote from: Alana_Jane on March 08, 2015, 07:18:04 PM
Hi Devlyn,
I thought I was a crossdresser... until I started to consider why I was interested in crossdressing, my identity is female and she wanted to just dress pretty.
I ended up at my Endocrinologist's office after I'd had about 6 weeks of therapy and my therapist gave me the verbal approval for HRT. I booked the appointment, and about two weeks before asked about what I'd need to bring with me to start hormone therapy. I went to the appointment in a cute polka-dot dress, light makeup, nude hose, and black flats, presenting as a middle aged woman in a dress. We had a good discussion, I mentioned my history with both crossdressing, I mentioned that there were touch points where I would mention to my mother that I was sure I wasn't male, then there was my 12yo boob growth spurt and how I was disappointed when it stopped, and more. In the end she agreed, I had GD, and at my next consultation I'll be starting HRT.
I'd highly recommend you at least work with you Primary Care Physician, to see where your levels are. Bio-identical's do work, but there's a danger in the fact you don't really know how much you're getting, and its efficacy at regulating your levels. That's what you should really consider: get the proper tests, and if you stick with BI get some follow up tests to see how it's affecting you levels. This is really important that you have a good handle on it, because this can be serious if it's not right. I imagine that's the motive for not mentioning dosing in the TOS, because the levels are different because we are each unique. It probably doesn't matter that you're not exactly femm, or want to move a little closer to being femm, the end result is that you have the desire to change your hormone balance to the point you're getting feminine secondary sexual characteristics.
-Alana
Thanks for the information, my supplement actually is regulated, but you're right, I don't know what my levels are, other than high enough to start feminization.
Hugs, Devlyn
Quote from: Jill F on March 08, 2015, 07:22:19 PM
My therapist told me to call him and mention that I am her patient.
OK, thanks!
Hugs, Devlyn
Quote from: Abysha on March 08, 2015, 07:25:02 PM
An "exotic hybrid"... I think you should be in charge of all labeling in the TG spectrum. Sounds awesome.
To answer your question, I don't see why not. I think the gut instinct is to say "no" because most people don't see non-transitioning cross-dressers as "hybrids". If they met more people like you and not based it on media stereotypes, I think it would change the landscape of it. And you are right, there is a sort of exotic romanticism in what you are doing. You are probably a walking prototype for the future of humanity for all we know.
Your post has me grinning from ear to ear! ;D I stole exotic from Shantel, I hope she doesn't mind!
Hugs, Devlyn
I showed up at Mazzoni and did an intake. I was fragile. The Social worker asked why I was there and I said I am transgender and wanted HRT. She asked how I knew. I went on for an hour and went through a lot of tissues. Then I asked her if she had any other questions. She said no and gave me a therapist card they work with. 5 months later I was on HRT.
I did not know what dysphoria was. After a few sessions, perhaps 6, with my therapist I asked what dysphoria was and did I have it. She said you have it very bad and rattles off a dozen or so examples I had told her.
Quote from: Alana_Jane on March 08, 2015, 07:18:04 PM
I thought I was a crossdresser... until I started to consider why I was interested in crossdressing, my identity is female and she wanted to just dress pretty.
Despite all the common threads, it is always interesting how different transgender experiences can be... I was completely the other way around. I've known since I knew anything about the difference between boys and girls that I wanted a female body. But until I started seriously thinking about coming out (30ish years later...) I never even considered wearing women's clothing.
Now I love it and look forward to going public (and hopefully getting some curves so it wears a little more comfortably). But my motivating factor has always been being stuck with the wrong parts.
Quote from: jeni on March 08, 2015, 08:25:32 PM
Despite all the common threads, it is always interesting how different transgender experiences can be... I was completely the other way around. I've known since I knew anything about the difference between boys and girls that I wanted a female body. But until I started seriously thinking about coming out (30ish years later...) I never even considered wearing women's clothing.
Now I love it and look forward to going public (and hopefully getting some curves so it wears a little more comfortably). But my motivating factor has always been being stuck with the wrong parts.
You know Jeni, just as each of use is a unique flower, our path to self realization is just as unique. As I've been briefly involved with other crossdressers over the past year, it seems that it can be(but not always) indicative of something deeper.
In my case, My one and only purge came after I realized that to me, if I continued I would want to transition and I wasn't ready to be an open and out transexual. I felt as an fundi-christian I would be damming my eternal soul to hell, that I would wind up on the street with no way out. I saw all the negative possibilities of being a TS in the early '90s. This lead me to the conclusion the only way to deal with this was to purge then bury this as a dark secret. But in the end, I should know the truth, and the truth set me free. Not free from being trans, but to embrace my trans nature.
"Spread your wing and fly away... Butterfly!"
Alana