Hey there, I have my first appointment with my gender therapist on the 9th. I'm really excited to go, but my mom told me that the doctor said she won't be the only doctor I need to see to get my letter for T. Which I'm confused about, because that is really the whole reason why I want to see a therapist. It sounded like she said that Dr. Stein (my therapist) will have to refer me to another doctor, who can then give possibly give me a letter. I did not know it was this complicated, and Dr.Stein is very expensive for my family, I really want to be able to get my letter as quickly as possible.
I guess my real question is, do I have to go through more than 1 therapist to get a letter? Is the entire process more complicated than I thought?
Thank you
I guess this would really all depend on laws where you live and who you're planning on getting T through. Typically, you'll need to see either an internalist/endocrinologist, I've seen a couple people go to a urologist, or an experienced general practitioner. These are usually who monitor your T levels every couple months; a gender therapist usually gives you a letter that you then take to a doctor, or sometimes a gender clinic, depending on where you're at and what's available. As far as I know, however, usually a gender therapist can prescribe a letter for T on their own, so yeah, I'm a little confused on that part if that's actually what he meant.
I'd say keep looking forward to talking to your therapist.
Not being excited, maybe just looking forward a bit.
Because you are not an adult yet it might be possible a second letter is needed.
I'd say just ask your therapist.
Its also possible its a misunderstanding and a second letter would be needed only for some surgeries.
hugs
I had an experience like that. I ended up going the informed consent route, but my original therapist did tell me she would have to refer me to someone else for a letter- she said she didn't know enough about T to be willing to write the letter. It was still good I went to her, but yeah, I would have had to get a letter from another therapist.
I live in California, I don't know what laws there are specifically about getting T unfortunately :/ . I'll definitely ask about it when I first see her, I'm just impatient and thought to ask now :P.
Quote from: CursedFireDean on May 30, 2015, 02:41:40 PM
I had an experience like that. I ended up going the informed consent route, but my original therapist did tell me she would have to refer me to someone else for a letter- she said she didn't know enough about T to be willing to write the letter. It was still good I went to her, but yeah, I would have had to get a letter from another therapist.
I do know that my therapist is experienced with trans issues, she's being a gender therapist for around 15 ish years, so I know that she knows what she's doing, but it's weird how I might need to see another doctor to get a letter. I think she mentioned a psychiatrist? Idk, I guess I'll see. It's just getting harder and harder to see my friends going through puberty and I'm going through the wrong one.
Thanks all
Quote from: Pizzaparty78 on May 30, 2015, 08:16:11 PM
I live in California, I don't know what laws there are specifically about getting T unfortunately :/ . I'll definitely ask about it when I first see her, I'm just impatient and thought to ask now :P.
I do know that my therapist is experienced with trans issues, she's being a gender therapist for around 15 ish years, so I know that she knows what she's doing, but it's weird how I might need to see another doctor to get a letter. I think she mentioned a psychiatrist? Idk, I guess I'll see. It's just getting harder and harder to see my friends going through puberty and I'm going through the wrong one.
Thanks all
*hugs*
keep on keeping on.
Well you might tell them exactly that... and that you would prefer to go on t. Maybe in a matter of fact way :) .
Time will pass quickly till your appointment.
hugs and wish you luck :)
In Colorado I had to go to a Therapist who then released me to another physician at a different clinic. Basically what happened was I had several appointments with my therapist before being diagnosed with G.I.D. Once I was diagnosed she gave me a list of physicians who worked with Transgender individuals to go to. I made an appointment with the physician and she told me I needed to be released by my therapist in order to start therapy. I got and delivered the release form to my Doctor and my therapist sent her a "T Letter".
I never received a physical copy of the Testosterone Letter from my therapist as I didn't need it. The Therapist and Physician were working together through calls and E-mails to give me the hormones I needed.
It's different for a lot of people.
If you want to avoid having to see several doctors then your best bet would be to see a Psychiatrist and not a therapist as the Psychiatrist can prescribe testosterone for you to pick up.
Quote from: Pizzaparty78 on May 30, 2015, 08:16:11 PM
I do know that my therapist is experienced with trans issues, she's being a gender therapist for around 15 ish years, so I know that she knows what she's doing,
Don't bank on this. I know a SoCal therapist who had been doing gender therapy for a long time, and she royally screwed my friend. My friend was emotionally distraught for ages afterward, and on top of it all, he never did get his top surgery letter. I wondered whether he was being a bit melodramatic until I talked to another trans guy's mother and heard their story.
I'm not trying to scare you; I just don't want you to equate experience with expertise and empathy. Just be careful until you see which way the wind blows.
Quote from: Rengar on May 31, 2015, 01:44:03 AM
If you want to avoid having to see several doctors then your best bet would be to see a Psychiatrist and not a therapist as the Psychiatrist can prescribe testosterone for you to pick up.
Man, it took me and my family forever to find a therapist, and now knowing that it's faster to find a psychiatrist instead = >:( . I've just been hearing so much about seeing a gender therapist for the past 3 years, that I thought that this was the best way. Well, I guess I'll see where it takes me. The worst part is how expensive seeing her is. P.S. I see that you play LoL, Rengar, nice :) .
Quote from: Arch on May 31, 2015, 02:10:46 AM
Don't bank on this. I know a SoCal therapist who had been doing gender therapy for a long time, and she royally screwed my friend. My friend was emotionally distraught for ages afterward, and on top of it all, he never did get his top surgery letter. I wondered whether he was being a bit melodramatic until I talked to another trans guy's mother and heard their story.
Considering that I live in SoCal, this is a bit scary, I hope that this isn't the same doctor, but I highly doubt it. Thank you for putting all this into perspective.
The therapist I'm talking about is not a Dr. Stein (nor is another therapist I've heard some bad things about). If someone at Susan's ever mentions the name of a practitioner whom I know to be questionable, I generally send a PM. I've never even heard of Dr. Stein, and I'm not sure where she is located. But if gender identity is one of her specialties, then she should be qualified and willing to refer you for T if you are stable and very clear about wanting to go that route.
Another thing to either ask during your first session or before (maybe via e-mail) is whether Dr. Stein follows the treatment guidelines issued by the World Professional Association for Transgender Health (commonly known as WPATH). These guidelines were made for trans* care, by trans* doctors, lawyers, etc. in order to eliminate a lot of the patronising behaviour often imposed upon trans patients seeking care. This can especially make acquiring T difficult, as WPATH eliminates the need to wait a year or whatever in your gender-confirming identity.
My gender therapist used WPATH and I had my letter in a number of weeks; granted, I was not diagnosed with depression or anxiety, so take my results with a grain of salt. WPATH generally recommends that other issues/medical concerns be resolved or treated <i>before</i> prescribing HRT.
Quote from: Pizzaparty78 on May 30, 2015, 08:16:11 PM
I do know that my therapist is experienced with trans issues, she's being a gender therapist for around 15 ish years, so I know that she knows what she's doing, but it's weird how I might need to see another doctor to get a letter. I think she mentioned a psychiatrist? Idk, I guess I'll see. It's just getting harder and harder to see my friends going through puberty and I'm going through the wrong one.
Yeah the first therapist I saw WAS experienced, that's why it was so annoying. She knew all about trans people, but the reason she wouldn't do the letter was she didn't know about hormone effects. I assume she was just too lazy to learn, I didn't like her or the person she wanted to refer me to.
In my experience of seeing an experienced therapist for one session when trying to get my top surgery letter she basically said "I require you to see me 6 months and that is why surgeons accept my letters". Now imagine that in the most snooty voice; is how I hear it in my head when she said it. That was followed by her not even guaranteeing me a letter after those 6 months. Yeah wasn't going to waste my time with her.
Go with your gut and be forceful to know when the soonest they will be willing to give you what you want. If they cannot give you a time frame upfront and/or try to skid around the question aka "well it depends on how the sessions go" then run far away.
Quote from: Pizzaparty78 on May 31, 2015, 02:28:56 AM
Man, it took me and my family forever to find a therapist ...
Considering that I live in SoCal, this is a bit scary, I hope that this isn't the same doctor, but I highly doubt it. Thank you for putting all this into perspective.
Here might be some alternatives, just to calm you down... you might see tht as fallback ... :
https://www.susans.org/forums/index.php?topic=187135.0
Thank you all so far, all the information you've given has been immensely helpful.
@Andrew, I'll probably ask her when I first see her, it'll definitely be a good thing to ask her. I hope she does follow those. Btw, I notice the WPATH guidelines say at least 3 months of therapy or documented real life experience, if I've been out for 2 months to my family and friends, does that count?
Quote from: CursedFireDean on May 31, 2015, 05:15:02 PM
Yeah the first therapist I saw WAS experienced, that's why it was so annoying. She knew all about trans people, but the reason she wouldn't do the letter was she didn't know about hormone effects. I assume she was just too lazy to learn, I didn't like her or the person she wanted to refer me to.
That is annoying, not that great of a therapist since she couldn't refer you, so hopefully that isn't the case with Dr. Stein. We found out about her from the LGBT center in my city, they gave us a list of Trans friendly therapists.
@Alex that doesn't sound good either, good thing you knew what to do though. I'll make sure to ask her for a time frame, and being as impatient as I am, I won't forget to ask.
Quote from: Laura_7 on May 31, 2015, 06:22:59 PM
Here might be some alternatives, just to calm you down... you might see tht as fallback ... :
https://www.susans.org/forums/index.php?topic=187135.0
That is awesome, thank you. If Dr. Stein doesn't work out, I'll probably try looking into some of them, and considering some of them are around $100 cheaper, my parents will probably approve as well.
I apologize for the long post, but another question, since I'm under 18, if I were to start T, would I need blockers as well with it? Will it also make it more difficult to get a letter considering I am younger? Thanks again
Quote from: Pizzaparty78 on May 31, 2015, 06:53:13 PMThat is awesome, thank you. If Dr. Stein doesn't work out, I'll probably try looking into some of them, and considering some of them are around $100 cheaper, my parents will probably approve as well.
*Cough*
If you don't mind my asking, exactly how much does she charge per session? My therapist costs $150 per session, but he has thirty-odd years of experience (and many years of experience with trans people), so he might be a bit on the expensive side. He also offered me a reduced rate for a couple of years because he knew I couldn't afford him otherwise. I was recently looking into another therapist nearby who claims to help with gender identity, and he apparently charges $120 per hour. So you might try someone else on the center's list. Of course, your city might be pricier than mine.
Also, does the LGBT center offer counseling? Mine usually has a waiting list that becomes particularly lengthy as summer approaches (I guess the interns take summers off). I'm not sure how good the counseling is, but the fee was something like $20 or $25 in 2008. I was calling in late July and would have had to wait a few months, so I opted for my current therapist. (At the time, his fee was $135, which I could afford because I was still with my ex.)
If finances are that important, you might want to look around a bit more.
Quote from: Arch on May 31, 2015, 07:13:27 PM
*Cough*
If you don't mind my asking, exactly how much does she charge per session? My therapist costs $150 per session, but he has thirty-odd years of experience (and many years of experience with trans people), so he might be a bit on the expensive side. He also offered me a reduced rate for a couple of years because he knew I couldn't afford him otherwise. I was recently looking into another therapist nearby who claims to help with gender identity, and he apparently charges $120 per hour. So you might try someone else on the center's list. Of course, your city might be pricier than mine.
Also, does the LGBT center offer counseling? Mine usually has a waiting list that becomes particularly lengthy as summer approaches (I guess the interns take summers off). I'm not sure how good the counseling is, but the fee was something like $20 or $25 in 2008. I was calling in late July and would have had to wait a few months, so I opted for my current therapist. (At the time, his fee was $135, which I could afford because I was still with my ex.)
If finances are that important, you might want to look around a bit more.
Dr. Stein charges $180 a session, but she lowered it to $150 for my family. My mom went through the list and called up most of the people on it, Dr. Stein was the only one who had room in her schedule, was nearby, and responded.
When I emailed The Center (As it's called), asking about their counselling services, they responded with this list. I guess they don't directly offer counselling, but refer you to one of the therapists. Or maybe I just missed it. So if they do, and it's $20-$25 like it was near you, that'd be a lot better. Although finances are important, my family is willing to try Dr. Stein and see how things go. Although, if we could find a better alternative, I'll let my parents know.
Quote from: Pizzaparty78 on May 31, 2015, 06:53:13 PM
I apologize for the long post, but another question, since I'm under 18, if I were to start T, would I need blockers as well with it? Will it also make it more difficult to get a letter considering I am younger? Thanks again
As far as I know, with ftm people t is enough, it drives down the estro, so you need either t or blockers. But you might talk that also through with your endo.
If you are 100% wanting T and your parents are 100% on board with you and you don't need actual therapy and if an endo nearby accepts Dr. Graham's letters this might be a way to go http://gendertherapist.com/ No hassle, letter is guaranteed.
This is what I ended up doing for my top surgery letter, several others here have used him as well.
Thanks Laura, from what I've heard, it seems blockers are pretty pricey, so it'd be nice if I wouldnt have to use them in the future.
Quote from: Alexthecat on May 31, 2015, 07:30:59 PM
If you are 100% wanting T and your parents are 100% on board with you and you don't need actual therapy and if an endo nearby accepts Dr. Graham's letters this might be a way to go http://gendertherapist.com/ No hassle, letter is guaranteed.
This is what I ended up doing for my top surgery letter, several others here have used him as well.
While I'm 100%, I'm not sure about my parents. If I were to go through with Dr. Graham, which seems to be the easiest way, I'll have to find and contact an endo and then talk to them. That sure would be simple though if that endo accepted Dr. Graham's letter. I'll have to keep him in mind, thank you.
I don't know where you were reading about WPATH, but this is directly from the latest edition regarding hormone therapy criteria:
Quote1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC outlined in section VI);
4. If significant medical or mental health concerns are present, they must be reasonably well controlled.
Or, in the case of adolescents:
Quote1. The adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity
or gender dysphoria (whether suppressed or expressed);
2. Gender dysphoria emerged or worsened with the onset of puberty;
3. Any coexisting psychological, medical, or social problems that could interfere with treatment
(e.g., that may compromise treatment adherence) have been addressed, such that the
adolescent's situation and functioning are stable enough to start treatment;
4. The adolescent has given informed consent and, particularly when the adolescent has not
reached the age of medical consent, the parents or other caretakers or guardians have
consented to the treatment and are involved in supporting the adolescent throughout the
treatment process.
You can read the entire document here, if you're curious: http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf)
Sometimes it helps if you find yourself dealing with uninformed medical staff or therapists in regards to WPATH, to inform yourself first and then offer them your findings if theirs are outdated. Hope this helps, brother!
Thanks so much Andrew, I must've been reading outdated stuff. I definitely think I fulfill everything on that list, I dont think I have any other mental health things to worry about either. Hopefully things will go well with Dr. Stein and hopefully be on my way to T in not too much time. And if that doesnt work out, maybe finding someone online.
Hopefully it works out as planned, dude! Your teen years are pretty crucial, you should definitely spend them running on the right 'juices' if at all possible. ;) I know the feeling, I was totally nervous about how long it'd take to get on T after my first visit; my therapist totally surprised me with a letter after only 2 sessions (in about just as many weeks, to boot!). I wish you that same pleasant surprise!
Hey sorry to bring this back up, but I just had my first appointment today and now have a few questions.
1. My therapist was telling me how we could go see an endo about asking for T, and then they'll tell me whether I can start it or not, depending on my age and all. She didnt even mention a letter or anything. So does that mean, since I have my parent's permission, that as long as the endo says yes then I can be prescribed T?
2. My family has found a way to get a therapist through Kaiser, our insurance, for much cheaper and there are a couple trans-friendly endos, could be just make an appointment with one of them about getting T right now? Or should we go see one of the Kaiser doctors? Thank you
Quote from: Pizzaparty78 on June 09, 2015, 11:26:46 PM
Hey sorry to bring this back up, but I just had my first appointment today and now have a few questions.
1. My therapist was telling me how we could go see an endo about asking for T, and then they'll tell me whether I can start it or not, depending on my age and all. She didnt even mention a letter or anything. So does that mean, since I have my parent's permission, that as long as the endo says yes then I can be prescribed T?
2. My family has found a way to get a therapist through Kaiser, our insurance, for much cheaper and there are a couple trans-friendly endos, could be just make an appointment with one of them about getting T right now? Or should we go see one of the Kaiser doctors? Thank you
So I don't have any experience with California laws, but I'm also on Kaiser in Oregon so maybe I can offer some guidance?
1. This will all depend on your state's informed consent laws, if available, as well as Kaiser policy. For me, I asked my primary care physician about HRT and he gave me a referral. That referral got me to an endo, who then sent in the referral for a therapist; without the referrals, specialist and extended care providers (such as therapists) aren't often covered by your insurance, as they haven't been deemed 'medically necessary/recommended' by a physician under Kaiser's umbrella of care. In Oregon, to get HRT, even on informed consent you have to receive a letter from a therapist stating that testosterone is the next step in your transition and that you are mentally and emotionally capable of giving informed consent on the matter.
Also, an endo won't usually just say 'yes,' they'll likely still require a letter or some sort of informed consent, but given that you're not 18 yet, this might be more of a discussion between your parents and your doctor at times than you, if you choose to forego Kaiser facilities and just find the nearest endo. They will be signing papers and paying for the medication, after all.
2. If you want your visits to the therapist covered, call your PCP, have them refer you to an endo, and then go visit that endo about testosterone. They might give you and your parents an informed consent form, order some bloodwork to make sure you're medically capable of handling T—or, if deemed too young, puberty blockers at the very least—and/or refer you to a recommended therapist near you. If all goes well, this should put you on the right track for HRT.
Hopefully this is of some use, although I'm hoping someone who's acquired T through a California Kaiser system will correct me on anything that might be different between state coverages and policies.
Good luck!
Quote from: AndrewB on June 10, 2015, 12:21:34 AM
So I don't have any experience with California laws, but I'm also on Kaiser in Oregon so maybe I can offer some guidance?
1. This will all depend on your state's informed consent laws, if available, as well as Kaiser policy. For me, I asked my primary care physician about HRT and he gave me a referral. That referral got me to an endo, who then sent in the referral for a therapist; without the referrals, specialist and extended care providers (such as therapists) aren't often covered by your insurance, as they haven't been deemed 'medically necessary/recommended' by a physician under Kaiser's umbrella of care. In Oregon, to get HRT, even on informed consent you have to receive a letter from a therapist stating that testosterone is the next step in your transition and that you are mentally and emotionally capable of giving informed consent on the matter.
Also, an endo won't usually just say 'yes,' they'll likely still require a letter or some sort of informed consent, but given that you're not 18 yet, this might be more of a discussion between your parents and your doctor at times than you, if you choose to forego Kaiser facilities and just find the nearest endo. They will be signing papers and paying for the medication, after all.
2. If you want your visits to the therapist covered, call your PCP, have them refer you to an endo, and then go visit that endo about testosterone. They might give you and your parents an informed consent form, order some bloodwork to make sure you're medically capable of handling T—or, if deemed too young, puberty blockers at the very least—and/or refer you to a recommended therapist near you. If all goes well, this should put you on the right track for HRT.
Hopefully this is of some use, although I'm hoping someone who's acquired T through a California Kaiser system will correct me on anything that might be different between state coverages and policies.
Good luck!
Thanks so much Andrew, you've been of huge help. I used to live in Oregon btw, even if that's unrelated lol. My parents have scheduled an appointment with some Kaiser doctors, idk if it's with my PCP or anything, I just know it's with some doctors who have been informed about the situation of me being trans and all. My parents seem to be on board with everything, so I guess I'll see how the discussions go with us and the doctors, I hope this will all go over smoothly and I'll be able to start taking T in not too long of time. Thank you again man.
Quote from: Pizzaparty78 on June 10, 2015, 12:43:23 AM
Thanks so much Andrew, you've been of huge help. I used to live in Oregon btw, even if that's unrelated lol. My parents have scheduled an appointment with some Kaiser doctors, idk if it's with my PCP or anything, I just know it's with some doctors who have been informed about the situation of me being trans and all. My parents seem to be on board with everything, so I guess I'll see how the discussions go with us and the doctors, I hope this will all go over smoothly and I'll be able to start taking T in not too long of time. Thank you again man.
No problem! I know I wish I would have had a lot more guidance when dealing with doctors and such, especially when it came to Kaiser and their policies, so I'm happy to help now that I've been through the whole ordeal. It sounds like you're extremely lucky to have such supportive parents, and also that you're in a state that's so chill with HRT, as far as I'm aware. So long as you have a goal in mind, I'm sure you'll hit it, given how everything's gone so far.
Oh, and feel free to message me any time, I'm happy to help out.