Susan's Place Transgender Resources

Currently the WPATH guidelines and nearly all well-regarded surgeons require a year of living as the sex you will be reassigned to before getting SRS, regardless of the the situation. This has come to be called RLE or real life experience. This has been discussed in a recent thread (https://www.susans.org/forums/index.php/topic,193920.0.html) and a column on susans.org. (https://www.susans.org/2015/08/03/rle-civil-rights-issue/).

What do you think? Should surgeons require RLE for all patients or should it be up to the patient whether RLE would be helpful?

My choice in the poll is entirely predictable, - optional only.

Its really a tough call between the two either way. There's just too many issues with both for them to work.

I feel like it should be a decision between yourself, your doctor and any therapist you are seeing at the time.

Its not really something that a lot of people can determine for themselves. You may feel like you don't need to go through it but underlying issues arise afterwards and now you're regretting going through so soon. Others know right away and no amount of RLE changes how you feel.

I myself felt like the latter and while I resented having to go through a whole year before I could get the letters to be approved for surgery, it also helped me grow and have a chance to see how everything is changing before one of the biggest changes in my life will occur (2 1/2 months to go!!!!) I no longer resent going through the 1 year RLE but it does annoy me a bit that it delayed the surgery.

back to my original opinion though, with a consult between your therapist and doctor, they can help determine if you would be one of those that won't really get anything out of the RLE and be able to write up like an exception letter stating that they feel that you are prepared for surgery.

Of course you'll still get the people that talk about liability if whoever is getting the surgery regrets and blames whoever thought they should but that happens all the time anyway.

I lived as a woman full-time for over two years before getting GRS, just because that's how long it took me to save up the money for it. I still don't think that that experience taught me anything about what having different genitalia would be like; I learned a lot about how women are treated in society, but the funny thing is, I was able to get those lessons just fine with a penis. ;) The only thing GRS changed for me was my relationship with my own body (and my wife's relationship with it, to be fair). By that point nobody I interacted with had any idea what my bits looked like anyway, and while there was definitely a learning curve to having and caring for a vulva and vagina, it's not like presenting as female while clothed did anything to give me a head start on that either.

The whole point of transitioning is to help you intergrate into society as you desire to be.
And if your not already active in the comunity there is no garantie you will be after srs.
The funny part about all this is, is that many of us have already been RLE, long before RLE related documentatin is requested. And knowing I presented in public mounths before my legal name change, and my name change document being my first related document, I feel robbed of those months.

The real problemb of RLE is how you are exspected to do it. I mean say your MtF and your a tomboy, the clothes you wear might be preferably male patten, both before and after, so even in this sence you might allready be pressenting as you wish too, but some people may sugest since your MtF, your not presenting as F, so you have no F related RLE.

I understand the nescessity for RLE, but what needs work is what RLE requires. (that is what needs to be changed)
Its the steriotypes even within the trans comunitty itself that need tearing down, for RLE to work for everybody.
And although, at the moment RLE isnt as acomadating as it should be. I still think that it should be required, but it needs to be made to work around everyone, instead of making people work within it.

I think it should be required.  The risk of regret it too great.  Its different thinking about being a woman and actually living as a woman.

IF THE PROBLEM IS SO BAD THAT THERE IS SIGNIFICANT MENTAL ANGUISH, UNDER THE CURRENT GUIDELINES, THE REQUIREMENT CAN BE WAIVED....

In essence, it really is between you, your psych and the performing surgeon.  I know because they waived it for me..

Jen

Quote from: ButterflyVickster on August 14, 2015, 10:37:57 AM
I understand the nescessity for RLE, but what needs work is what RLE requires. (that is what needs to be changed)
Its the steriotypes even within the trans comunitty itself that need tearing down, for RLE to work for everybody.
And although, at the moment RLE isnt as acomadating as it should be. I still think that it should be required, but it needs to be made to work around everyone, instead of making people work within it.

I am skeptical that it can be changed to fix this problem. Stereotypes run deep, and plenty of doctors and therapists still follow guidelines that are decades out of date. Your tomboy example nails the main problem I have with it, and I do not see a way to resolve this. Gender expression varies so widely that I would challenge anyone to come up with a definition for RLE that is fully inclusive. I warrant that this is impossible, so the only non-discriminatory definition of RLE would amount to asking the patient if they've been presenting as they intend to present. Since all it takes is a "yes," this is essentially meaningless and there's no reason to bother with the pretense---just call it a waiting period to ensure the need for surgical transition is adequately persistent.

Quote from: JLT1 on August 14, 2015, 11:26:02 AM
I think it should be required.  The risk of regret it too great.  Its different thinking about being a woman and actually living as a woman.

The thing is, there is no reliable evidence that RLE prevents post-surgical regret any more effectively than randomly denying people access. Given the very low incidence of regret, unless RLE is unbelievably good at weeding out cases where regret is likely, its main effect is going to be denying needed treatment from good candidates.

I say "unbelievably" because, as others in this thread and the earlier one have pointed out, living in a female role and having female genitals are at best tenuously connected. The RLE test does not test at all for the preparedness for the anatomical change. It makes sense as a surgical prerequisite only if the goal is to ensure that surgery is available only to people who fit whatever standards of female or male presentation are needed to count as RLE. That does not strike me as a legitimate goal.

Quote from: jeni on August 14, 2015, 12:28:53 PM
I am skeptical that it can be changed to fix this problem. Stereotypes run deep, and plenty of doctors and therapists still follow guidelines that are decades out of date. Your tomboy example nails the main problem I have with it, and I do not see a way to resolve this. Gender expression varies so widely that I would challenge anyone to come up with a definition for RLE that is fully inclusive. I warrant that this is impossible, so the only non-discriminatory definition of RLE would amount to asking the patient if they've been presenting as they intend to present. Since all it takes is a "yes," this is essentially meaningless and there's no reason to bother with the pretense---just call it a waiting period to ensure the need for surgical transition is adequately persistent.

This statement has merit.  Making a non-gender normative individual who desires SRS be required to conform to a gender normative presentation does not make any sense.  This is why there are exclusions in WAPTH that are quite broad.  If an individual doctor does not follow ALL parts of a guidance and the most recent guidance does not mean the guidance is wrog, it means the doctor does not have the patient's best interest in mind.

Quote from: jeni on August 14, 2015, 12:28:53 PM

The thing is, there is no reliable evidence that RLE prevents post-surgical regret any more effectively than randomly denying people access. Given the very low incidence of regret, unless RLE is unbelievably good at weeding out cases where regret is likely, its main effect is going to be denying needed treatment from good candidates.

The only studies of which I am familiar with are those that show a 95+% success rate in terms of no surgical regret.  I am not familiar with any study which shows comparable data to this.  Something that shows that 95% of individuals who don't have a full year of RLE prior to SRS do not have regret would be great. 

The only credible evidence is that the current situation works 95% of the time for those who complete 1 year RLE.  There is no other qualitative information on dropouts, suicides ect.   

It seems that the bigger problem is that doctors use the one year requirement as an absolute rather than as a guide.... The second problem is a lack of information on the number of people who don't succeed in the 1 year RLE requirement.

How can something get better if we don't quantitatively know what is bad?

The current requirement at least works part of the time.  Allowances were made for unusual or problematic situations... 

How many people have actually read through the standard that seems to be so hated?  Then argued with the doctor????

Jen

Quote from: suzifrommd on August 14, 2015, 08:34:56 AM
Currently the WPATH guidelines and nearly all well-regarded surgeons require a year of living as the sex you will be reassigned to before getting SRS, regardless of the the situation. This has come to be called RLE or real life experience. This has been discussed in a recent thread (https://www.susans.org/forums/index.php/topic,193920.0.html) and a column on susans.org. (https://www.susans.org/2015/08/03/rle-civil-rights-issue/).

What do you think? Should surgeons require RLE for all patients or should it be up to the patient whether RLE would be helpful?

It should be optional; after all, excepting genderfluid or genderqueer people to live as either males or females before they can get SRS is certainly extremely unfair to these people. :(

My vote is the same as always. I intend to present male after srs so clearly I have a lifetime's RLE behind me already.

The merit in RLE prior to GRS is that it can help one realise they can in fact be their identified gender without needing surgery. I know that's exactly where I am at the moment... coming up to my second year of RLE I don't desperately feel the need for GRS because I am living as a woman and very happy with my life. But I am still actively considering surgery and likely to book soon because of a number of personal reasons. That said, I still feel that RLE should be optional with the caveat that the system needs to have some safety nets in place for those in a mad rush and/or unrealistic expectations.

Quote from: Ms Grace on January 30, 2016, 02:53:46 AM
The merit in RLE prior to GRS is that it can help one realise they can in fact be their identified gender without needing surgery. I know that's exactly where I am at the moment... coming up to my second year of RLE I don't desperately feel the need for GRS because I am living as a woman and very happy with my life. But I am still actively considering surgery and likely to book soon because of a number of personal reasons. That said, I still feel that RLE should be optional with the caveat that the system needs to have some safety nets in place for those in a mad rush and/or unrealistic expectations.

Out of curiosity--exactly what kind of real life experience would gender-fluid and genderqueer people have?

Quote from: AnonyMs on January 30, 2016, 01:31:46 AM
My vote is the same as always. I intend to present male after srs so clearly I have a lifetime's RLE behind me already.

Hang on--to clarify--are you a tomboy?

The guidelines are just that, guidelines not rules set in stone. Most doctors only require a letter from two mental health providers one required to be an MD.  Most providers will only give the letters after one year RLE and most insurance companies also require the 1 year RLE before they will pay for coverage. 

If you are willing to pay cash it is very possible to get your letters and have the surgery without having to go through the 1 yr RLE.  I know at least one member here who was able to get her surgery without having completed 1 year RLE.

As I've said before, requiring RLE before offering treatment is like sending a recruit into battle in order to train as a soldier.

I know there are some arguments for it, for instance it can prove your determination. It can also save the health carers money and I suggest this is the main reason for RLE. There might be a stampede were obstacles not put in the path.

However, it's an arse-about-face way of dealing with this in my opinion. At the very least, hormones should be prescribable prior to RLE as they are part of the enabling towards transition. Surgery in various guises can be optional. It's incredibly hard for some people to live in another gender without offering some of the medical benefits towards it at the start of 'RLE.'

There's also a mahoooosive gender binary agenda that propels this way of thinking, which may be changing slowly.

Quote from: Futurist on January 30, 2016, 02:55:44 AM

Quote from: AnonyMs on January 30, 2016, 01:31:46 AM
My vote is the same as always. I intend to present male after srs so clearly I have a lifetime's RLE behind me already.

Hang on--to clarify--are you a tomboy?

No, but social transition is a big risk for me, so it seems only logical to manage my dysphoria by other means. If I can delay transition by having SRS then why not? I don't see any reason to do it in the other order.

The hoops of the standards of care aren't really obstacles and it's not like you can charge straight to SRS without living some kind of life. It's good to think about it for a bit and make sure its' right, so I say keep the RLE. When I was starting off it seemed like too much, bowing and scrapping to get my way, blah blah the usual. In hindsight the standards of care or whatever they call it today was a pretty minimal impact on my transition and life.

I thought following WPATH was for people asking insurance to pay for their surgeries? I thought people paying with cash could just go to the doctor and get the treatment they want.

In the UK you need to demonstrate social transition has been taking place as a prerequisite for all NHS funded treatment including hormones. This means at least two and possibly three appointments to the GIC. The first of those now typically involves a one-year waiting list. No wonder it causes so much angst, self med and self harm.

At least, that's how the rules and regs are currently interpreted.

Quote from: Devlyn Marie on January 30, 2016, 08:19:20 AM
I thought following WPATH was for people asking insurance to pay for their surgeries? I thought people paying with cash could just go to the doctor and get the treatment they want.

Not my experience. Surgeons wanted some indication that we had been evaluated by a therapist and that we wouldn't regret our surgery.

Quote from: suzifrommd on January 30, 2016, 09:57:57 AM

Quote from: Devlyn Marie on January 30, 2016, 08:19:20 AM
I thought following WPATH was for people asking insurance to pay for their surgeries? I thought people paying with cash could just go to the doctor and get the treatment they want.

Not my experience. Surgeons wanted some indication that we had been evaluated by a therapist and that we wouldn't regret our surgery.

You paid out of pocket, or with your insurance?

Quote from: Devlyn Marie on January 30, 2016, 10:51:24 AM
Not my experience. Surgeons wanted some indication that we had been evaluated by a therapist and that we wouldn't regret our surgery.


You paid out of pocket, or with your insurance?

Out of pocket.

Quote from: Richenda on January 30, 2016, 03:23:40 AM
As I've said before, requiring RLE before offering treatment is like sending a recruit into battle in order to train as a soldier.

I know there are some arguments for it, for instance it can prove your determination. It can also save the health carers money and I suggest this is the main reason for RLE. There might be a stampede were obstacles not put in the path.

However, it's an arse-about-face way of dealing with this in my opinion. At the very least, hormones should be prescribable prior to RLE as they are part of the enabling towards transition. Surgery in various guises can be optional. It's incredibly hard for some people to live in another gender without offering some of the medical benefits towards it at the start of 'RLE.'

There's also a mahoooosive gender binary agenda that propels this way of thinking, which may be changing slowly.

Well said, Richenda.

I understand the motivation behind the RLE requirements, but I do not agree with them. Cis-women do not go out into the world with the wrong genitalia, or in constant fear of being outed as the wrong gender. How is that "real life"?

I do understand that experiencing how women, cis or trans, are actually treated in society may be a shock for some.  At my age (I am 58) I really wouldn't care.  I have had a lifetime of male privilege, and I am near the end of my professional career, so missed promotions or raises wouldn't bother me.  Socially, being talked over, ignored, disrespected or intimidated would be hard to deal with, but I really don't know how that has any bearing on being allowed to have SRS. 

I assume the argument is that if you find RLE traumatic you wouldn't want SRS.  For me, that makes no sense. It's transition that's hard, and for me, I would rather have SRS first and then do my "RLE", because I want every psychological advantage. 

I already don't function as a male sexually, even before starting HRT.  I haven't had sex in more than three years, and maybe only twice the last six. (I say "maybe" because it was so unsuccessful I don't know whether it counts as sex.)  I have no use for a penis. I love the female form, and even if I were abstinent, I would rather have a nice, pretty vagina.

Quote from: Jessie Ann on January 30, 2016, 03:13:45 AM
The guidelines are just that, guidelines not rules set in stone. Most doctors only require a letter from two mental health providers one required to be an MD.  Most providers will only give the letters after one year RLE and most insurance companies also require the 1 year RLE before they will pay for coverage. 

If you are willing to pay cash it is very possible to get your letters and have the surgery without having to go through the 1 yr RLE.  I know at least one member here who was able to get her surgery without having completed 1 year RLE.

This is good to hear.  My therapist told me much the same thing.  I find the WPATH guidelines very intrusive and they are going to make my transition harder.

~Terri

Quote from: suzifrommd on January 30, 2016, 10:59:30 AM

Out of pocket.

OK, thanks. To answer the original question, I guess RLE is fine if it considers all of the possible living experiences. Examples given: Man with vagina, woman with penis, man with breasts, woman without breasts, genderless, etc. And clothing choices during that year? pffffft, don't even try it. What are the medical professionals trying to evaluate, fashion sense or medical needs?

I believe in having the RLE as a requirement.
Although I believe that individually it is not necessary before SRS.

I am for it for the very few who regret having SRS and because it gives ammo to our enemies to use against us when this happens.

I'm in the optional group with the caveat the person not going through RLE should be heavily screened before any letters are written for GCS. 

I for one strongly believe in rle, for of your wanting to be female or male you should start living that role everyday to see how it feels...would you buy a car without test driving it first to see how it handles and fits your personality? I don't understand the balking at rle, they make prosthetics to help you along..so what's wrong with the test drive before before buying the body you want?

Quote from: cheryl reeves on January 30, 2016, 02:19:57 PM
I for one strongly believe in rle, for of your wanting to be female or male you should start living that role everyday to see how it feels...would you buy a car without test driving it first to see how it handles and fits your personality? I don't understand the balking at rle, they make prosthetics to help you along..so what's wrong with the test drive before before buying the body you want?

RLE doesn't test drive having a vagina. I have a lesbian friend who dresses in what would be considered a male style and know plenty of other women who do that too.are they unprepared to own the vaginas they have?  What RLE gives you is a test drive of wearing a skirt and fitting into archaic notions of gender roles. How does that prepare you for having a vagina?

Quote from: kira21 ♡♡♡ on January 30, 2016, 04:11:21 PM
RLE doesn't test drive having a vagina. I have a lesbian friend who dresses in what would be considered a male style and know plenty of other women who do that too.are they unprepared to own the vaginas they have?  What RLE gives you is a test drive of wearing a skirt and fitting into archaic notions of gender roles. How does that prepare you for having a vagina?

Buy a prosthetic vagina,I know it's not the same but it's cheaper then grs and gives you an idea of what being fem is like.

I thought we were discussing the validity of rle as a tool for preparing you for grs? Are you suggesting wearing a prosthetic for a year as rle?

This is TMI but I tried that once.  IMHO it's a huge waste of money.  It doesn't work as well as tucking and is intensely uncomfortable.


Sapere Aude

I suspect that RLE has more to do with the fear of a need to protect surgeons from liability claims than it does with predicting the success of a SRS patient.  SRS may be necessary for our emotional health, but hardly affects our physical health.  If we are expecting other people to pay (the taxpayers or private insurance), then they get to make the rules, but if your choice is not a burden on anyone else, then surgery on demand should be the rule.  FFS is more life-changing than is SRS, but much easier to get "on demand" to paying customers.  Same for BA.  Anyone can buy boobs of any size they want, however ridiculous, without anyone else's permission and no prior requirements to see if you really want to be that size. And I think we can attest that developing boobs on HRT, or obtaining them by a BA, is more life changing that is SRS.

WPATH seems to be the home of a lot of "old think" and reacting to fears that have not been shown to materialize.

Many people regret some of their own decisions, but as adults no one questions that they have the right to make those mistakes.  Why should SRS be any different, and people with gender dysphoria be put in some special class that needs to be controlled and protected by "the experts."

This is not to say that RLE can be very useful to some, or that there is anything wrong with RLE.  But mandate it as a requirement is wrong.

^^^ This^^^

Very well put. I agree completely.

~Terri

Quote from: XKimX on January 31, 2016, 06:58:56 PM
I suspect that RLE has more to do with the fear of a need to protect surgeons from liability claims than it does with predicting the success of a SRS patient.  SRS may be necessary for our emotional health, but hardly affects our physical health.  If we are expecting other people to pay (the taxpayers or private insurance), then they get to make the rules, but if your choice is not a burden on anyone else, then surgery on demand should be the rule.  FFS is more life-changing than is SRS, but much easier to get "on demand" to paying customers.  Same for BA.  Anyone can buy boobs of any size they want, however ridiculous, without anyone else's permission and no prior requirements to see if you really want to be that size. And I think we can attest that developing boobs on HRT, or obtaining them by a BA, is more life changing that is SRS.

WPATH seems to be the home of a lot of "old think" and reacting to fears that have not been shown to materialize.

Many people regret some of their own decisions, but as adults no one questions that they have the right to make those mistakes.  Why should SRS be any different, and people with gender dysphoria be put in some special class that needs to be controlled and protected by "the experts."

This is not to say that RLE can be very useful to some, or that there is anything wrong with RLE.  But mandate it as a requirement is wrong.

My clinic got shut down by adults who made mistakes, everyone else had to suffer because of it. (though RLE didn't stop that from happening)

Why do people assume you can't be a tomboy in RLE? Just wear what you are going to wear. There is a big difference between being a boy in jeans and t-shirt in society than there is being a girl in jeans and a t-shirt in society.

Can someone educate me on why an MTF doesn't want to live as female

Quote from: Serenation on January 31, 2016, 07:32:55 PM
Can someone educate me on why an MTF doesn't want to live as female

This was never the issue, dear. The issue was the WPATH dictates how one must transition.  My point is that it's my transition, my body, and my life. Transition is often difficult and scary, and we must each find our own paths. My path would include SRS first, then RLE, but then I would be penalized by having to pay out of pocket for something my insurance covers.

As you pointed out, RLE does not guarantee a more successful outcome. As XKimX said, it sounds more like a liability clause to protect medical professionals than a concern for the patient, and apparently it doesn't even do that. One already has to be vetted by two mental health professionals. That should be enough.

With kindness,

Terri

Quote from: Serenation on January 31, 2016, 07:32:55 PM
Can someone educate me on why an MTF doesn't want to live as female

Divorce and career/money to name two.

I think RLE is important.  Not for hrt, but certainly for such a life altering procedure as GRS.  This isn't like getting your ears pierced or a tattoo.  The consequences of regret are extreme, and just letting people alter themselves surgically can be devastating.  There is enough regret in the realm of cosmetic surgery to warrant more gate keeping there that we shouldn't put an already vulnerable population more at risk.

Transition regret is real.  I know a few.  Once you get the surgery it is much much harder to reintegrate as your old gender. 

Quote from: Oliviah on February 01, 2016, 09:18:13 AM
I think RLE is important.  Not for hrt, but certainly for such a life altering procedure as GRS.  This isn't like getting your ears pierced or a tattoo.  The consequences of regret are extreme, and just letting people alter themselves surgically can be devastating.  There is enough regret in the real of cosmetic surgery to warrant more gate keeping there that we shouldn't put an already vulnerable population more at risk.

Transition regret is real.  I know a few.  Once you get the surgery it is much much harder to reintegrate as your old gender.

I don't know anyone who's detransitioned, but I don't understand why having SRS would make it "harder to reintegrate as your old gender."? I'm interesting in presenting male afterwards, which is similar to detransitioning from a certain point of view, and I don't see any difficulty with it. If you were not transgender then I could see a possibility, but how would you manage to take HRT so long in that case?

I'm not part of the vulnerable population in any normal sense of the word. Not all of use are.

Rather it's required or not, HOW can a Doctor monitor your RLE? Are they going to assign an agent to you for a year to follow you around to make sure you are what you say?

How is there PROOF that you are doing it?

I myself WILL do the RLE because I know that when the time comes for me to go full time, I can stop wearing Halloween Costumes throughout the year in certain places where my "Current" legal name MUST be matched how I look.

I'm at the point where I'm afraid to present male in front of Family and Friends! Yes..It used to be the other way around in the past, but in certain settings I am still forced to present Male (Halloween Costume reference).

Over time it will change.  :)

Quote from: Oliviah on February 01, 2016, 09:18:13 AM
I think RLE is important.  Not for hrt, but certainly for such a life altering procedure as GRS.  This isn't like getting your ears pierced or a tattoo.  The consequences of regret are extreme, and just letting people alter themselves surgically can be devastating.  There is enough regret in the real of cosmetic surgery to warrant more gate keeping there that we shouldn't put an already vulnerable population more at risk.

Transition regret is real.  I know a few.  Once you get the surgery it is much much harder to reintegrate as your old gender. 

SRS has some of the lowest regret rates of any surgery.  By putting psych evaluations as mandatory for it,  when they are not for equally life changing medical procedures such as ivf,  you are saying that we are not capable of making our own evaluations.  Then there is the issue of the  fact that wearing a skirt doesn't prepare you for having a vagina.

Quote from: kira21 ♡♡♡ on February 01, 2016, 10:32:32 AM
SRS has some of the lowest regret rates of any surgery.  By putting psych evaluations as mandatory for it,  when they are not for equally life changing medical procedures such as ivf,  you are saying that we are not capable of making our own evaluations.  Then there is the issue of the  fact that wearing a skirt doesn't prepare you for having a vagina.

IVF is nothing like GRS.  Yeah regret is low, but that is because largely to gate keeping.  I know it is triggery to some people to even consider the fact a lot of people now a days are doing this all for very wrong reasons, but it sure is true.  Those people should not get GRS and will regret it.  Those people currently are not getting it due to gate keeping.  If it isn't your identity a doctor is doing harm to alter you.  Their oath is do no harm. 

Locked for review.

 :police:
Okay folks, we may not agree or understand why somebody wants to do certain things. However that doesn't give us an open invitation to criticize their reasons or make them seem less legit. Let's keep in mind TOS 9, TOD 10 and TOS 5.
Thanks
Mariah

Thread unlocked.

Quote from: Oliviah on February 01, 2016, 10:36:43 AM
IVF is nothing like GRS.  Yeah regret is low, but that is because largely to gate keeping.  I know it is triggery to some people to even consider the fact a lot of people now a days are doing this all for very wrong reasons, but it sure is true.  Those people should not get GRS and will regret it.  Those people currently are not getting it due to gate keeping.  If it isn't your identity a doctor is doing harm to alter you.  Their oath is do no harm.

IVF is not nothing like SRS,  it's exactly alike SRS in regards to the factors that I was comparing it...  It is life changing and a medical intervention. TBH i think a psych evaluation might be more useful for IVF.

I doubt very much that you could find any evidence to support the assertion that low regret rates are due to gate keeping.  The original wpath guidance on this wasn't even created with evidence to support it.

I have no vested interest in this, I am post op.  I don't think wearing  a skirt, pandering to someone else's notion of what 'living as a woman' entails,  would help prepare anyone for having a vagina.

Can rle even be defined? To define living as a woman,  one has to be prescriptive about how women should live and that's not right as women live in all sorts of ways.  Women can wear mens clothing, have names used by men,  I know women,  cis women who wouldn't pass this test. They have vaginas and it didn't do them any harm. Seriously, what is rle?  How does one show that one is 'living as a woman' ? Clothing? Long hair and make up? Feminine mannerisms? They don't make a woman. About the only concrete thing is having your gender marker changed on your passport and that doesnt prepare you for surgery.

What is IVF?

I have a dollar that says in vitro fertilization?

That's all I could come up with.  Still would like another option because the similarities are questionable.

Like, if I did IVF and had a baby I could give it up for adoption if it was beyond my capabilities to handle.  I couldn't do that with a vagina....

Thanks Devlyn

Hugs

Jen

I had worked in my role before seeking out my letters. I had known the two mental health professionals for a few months prior. I performed some volunteer work for them. One taught at a community college and I served on a panel for her sex ed classes covering our favorite subject. For the other, I helped moderate a support group which met once a week.

In both cases, they trusted me when I told them that I had been living the role for the required time period. I did not lie but I was right on the schedule. I couldn't wait to get under the knife. I'm sure that the requirements are more stringent now since some insurance companies and health care plans now cover the surgery.

I voted for RLE for this reason: I'd like to see GRS available to all who need it, to be covered  by all insurance, or by your nation's health care plan. Medical professionals really need protection for the services they perform and this is a big one. If they can point to stringent standards and a high rate of success, then the procedure could and should become mainstream. I believe this trumps what we want for ourselves in that it is good for everyone. We need better acceptance in society. We need the medical evidence of success and the support of the medical services community.

Personally, at the time I transitioned thirty years ago, I thought it was all a bunch of bunk. I've since changed my mind.

Cindi

Cindi

Sure you could give it up but that has pretty serious  consequences too! And many many people would not and even if they do, the pregnancy is pretty serious too! 

It's just an example I have seen used before of one of several other procedures that has important  consequences, that requires no psych evaluation. It's used as an indication that people often make important decisions about their lives, including in medical settings without the need for psych evaluation.

Quote from: Cindi Jones on February 01, 2016, 04:01:16 PM
I voted for RLE for this reason: I'd like to see GRS available to all who need it, to be covered  by all insurance, or by your nation's health care plan. Medical professionals really need protection for the services they perform and this is a big one. If they can point to stringent standards and a high rate of success, then the procedure could and should become mainstream.

But shouldn't they be required to prove that RLE somehow contributes to that high rate of success?

So far, I've seen no such proof. On the contrary, all the evidence I've seen is that RLE has no relation to post-surgical satisfaction.

Someone said WPATH is living in the past. That's undoubtedly true. I think what has to be remembered is the members are steeped in science. Absent scientifically derived evidence showing RLE is a waste of time, nothing will change. Either scientifically prove your hypothesis, or get over it.

I think part of our issue has to do with calling the MtF operation Gender Reassignment (or Confirmation) Surgery. Our gender is who we are; it's what's between our ears, what we know of ourselves. To us, there's no doubt about our gender, and no surgical procedure can enhance that. Whether we present as femme-fem or butchy-butch, our gender is our gender.

Conversely, walking around with an exposed vagina isn't how society classifies one's sex (that's sex as in the marker on your driving license) as female. Our sex, generally defined as genitalia, can be changed with a surgical procedure which some of us feel is our (constitutional/god given — take your pick) right to have on demand. But it won't make society classify us as woman, rather than man, because it's invisible unless naked.

So I'm torn. I get there are gender-queers who should have every right to a body of their choosing. But there are also those who intend to socially transition, and SRS is at the end of the process not the beginning. WPATH will never accommodate those who don't intend to live as a member of the sex not assigned at birth (unless you get data confirming that hypothesis). The only solution is to fake it. Show up at the shrink in convincing girl drag. Have a believable story.

I know I'm repeating myself, but the SOC, from Benjamin to WPATH, were designed to insure the best outcomes for those planning to live as women within society. They're not equipped to deal with the minority who are just uncomfortable with their birth-body. I don't have a clue how to resolve that.

There is also an issue of ethically based science. Since RLE has had good outcomes it would be unethical to set up a blind trial of X people in each group and see which ones had the 'best' outcomes.

No matter my personal opinion on RLE, I can't see how the medical community could put themselves in that dilemma.

My own personal opinion not to trample on anyone else's is that really your planning on living as a woman what's the big deal.

Quote from: stephaniec on February 02, 2016, 12:47:13 AM
My own personal opinion not to trample on anyone else's is that really your planning on living as a woman what's the big deal.

Can you define living as a woman please?

Quote from: kira21 ♡♡♡ on February 02, 2016, 01:43:01 AM
Can you define living as a woman please?

well to take a broad view and not to be sexist or anti woman or anything considered demeaning whitch I have absolutely no intention to do. Usually  one approaches living as a woman on the most basic and benign level as dressing as other woman dress which in and of itself leaves a lot of leeway . I mean on the most basic level any clothes whether be jeans or slacks that other woman purchase would suffice to fulfill any requirement as be perceive as dressing as the female as opposed to being dressed as a male even though many women blend clothing so in reality it really doesn't matter how one dresses to fulfill any clothing requirement . As far as other issues such as name change on documents and other legal means of existing within the framework of a specific gender if that's your purpose it seems only common sense if you want to be perceive by others as a specific gender .in which case what's the big deal of being perceive as that specific gender in order for the medical professional that's going to rearrange your genitals in order  for you to be perceived as that gender to try in the least offensive and least demeaning way to feel comfortable in surgically rearranging an organ that obviously plays an important individual and social role in your mental well being.

I'll define living as a woman, when you have to make a choice that says am I a man or a woman , you pick woman.

It doesn't need to be any more complicated than that.

Quote from: Serenation on February 02, 2016, 03:02:24 AM
I'll define living as a woman, when you have to make a choice that says am I a man or a woman , you pick woman.

It doesn't need to be any more complicated than that.

this is true . the reality of living in a society with established laws makes it more complicated when your asking someone else to do something to your body. That person you are asking lives under the same laws and is accountable for his/her actions. If a person chooses to live in  the jungle away from society and decides to performed operations on themselves or finds someone willing to do it well go for it. The question is basically about professional accountability as regards medical procedures and not whether there is some objective criteria of what the inherent nature of man or woman is.

Quote from: Cindy on February 02, 2016, 12:38:10 AM
There is also an issue of ethically based science. Since RLE has had good outcomes it would be unethical to set up a blind trial of X people in each group and see which ones had the 'best' outcomes.

No matter my personal opinion on RLE, I can't see how the medical community could put themselves in that dilemma.

Cindy, don't scientists and doctor do this all the time?

For example, try a non-surgical intervention such as physical therapy for some joint procedure and find out the outcomes are just as good? That surgery is an unnecessary risk and expense?

Given that RLE was not arrived at through any scientific means - it appears to have come off the top of someone's head in the '70s, wouldn't it be unethical NOT to determine whether it is really helpful?

Quote from: stephaniec on February 02, 2016, 12:47:13 AM
My own personal opinion not to trample on anyone else's is that really your planning on living as a woman what's the big deal.

But who, exactly, gets to decide that in order to have female-shaped genitals you must live socially as a female?

Quote from: suzifrommd on February 02, 2016, 05:49:06 AM

Cindy, don't scientists and doctor do this all the time?

For example, try a non-surgical intervention such as physical therapy for some joint procedure and find out the outcomes are just as good? That surgery is an unnecessary risk and expense?

Given that RLE was not arrived at through any scientific means - it appears to have come off the top of someone's head in the '70s, wouldn't it be unethical NOT to determine whether it is really helpful?

The first criteria in any medical trial is 'do no harm'. OK I work in a high risk area, the drugs we give people do harm (chemotherapy) but they are ethically justified as there is no alternative to 'let nature take its course'. Which we also do if the chemo regime' is going to increase morbidity over the expected life span of the patient. For example, I will not give chemo to an elderly client who has co-morbidities as it would reduce the limited life span they have.

We will put patients on clinical trials if there is an expectation that has been previously justified experimentally as having a potential to improve life over the current treatment. The ethical justification we go through for such treatments is detailed, and signed off at many levels.

In a blind study we do not know what we are giving to our clients, the worse treatment is the one that has been shown to give the best results (the existing treatment). As soon as there is any sign that an alternative is giving better or worse outcomes the trial is closed and everyone is put onto the new best treatment or the new treatment cancelled and the clients go back to the best available (which may be the existing treatment).

How can I do this for RLE? We can argue that RLE is unnecessary and that freedom of choice is better, but what proof do we have? We need to present evidence that freedom of choice is a better alternative than RLE.

The only experimental group we have to work with (I think) is Argentina that brought in treatment on demand. This was for both HRT and SRS. But the population in Argentina now have the largest detransition rate. This could be due to many reasons and not just due to treatment on demand, there are socioeconomic factors etc that have to be factored in for example. But how we factor them in to a model is extremely difficult. We are looking at life style, happiness, social acceptance, quality of life. All of which have many variables themselves.

In my clinical trials life is simple (I wish). I have parameters to measure, tumour load, complete or partial remission, time of remission, general physics health (yes hon I've cured you from leukaemia but you now have acute hepatic failure and have a week to live).

How do we do such trials on transgender people?

For a start the cohort is extremely difficult to create. I would need matched groups, with similar socioeconomic environments, socialisation, family and psychiatric support. Similar age groups and statistically meaningful power groups. Which just means my groups need to be large enough to ensure that any changes between the groups are statistically rigorous to mean the difference is due to my treatment (freedom of choice compared to RLE) than any other factor.

Now I cannot allow my clients or their treating medical support team know what group they are in (impossible obviously).

The major comorbidity in the fail group is severe depression and or suicide or self harm. Or detransition with all of the life long effects that carries following surgical intervention.

I ask you; how can I possibly reconcile that as a scientist to the major prerogative of 'do no harm'?

This is a Catch22.

Quote from: Cindy on February 02, 2016, 06:55:22 AM
I ask you; how can I possibly reconcile that as a scientist to the major prerogative of 'do no harm'?

Suppose a hospital performing knee replacements insisted that the patient walk around town wheeling a wheelbarrow for a month before the surgery, and then a standard knee replacement was done. And suppose they're getting excellent results.

Are you saying it would be a violation of "do no harm" to try to figure out whether the wheeling of the wheelbarrow for a month in any way contributes to the excellence of the outcome?

I.e. generations of patients would perform weeks of useless activity just because doctors had "always done it that way" and didn't want to jeopardize success?

Wouldn't the same logic have made it unethical to stop requiring RLE for HRT, which used to be standard, but we now know served little purpose?

Suzi, I have kept my opinions on RLE to myself. I was trying to answer the question logically and not emotionally.

Patients going for allo cardiac vein transplants to correct blocked veins in their heart now go onto a treadmill for a few weeks prior to the removal of the leg vein for transplantation into their heart. It has dramatically improved life outcome.
It use to be thought a dumb idea to force patients who had a cardiac arrest to do exercise. It is now standard.

As for knee surgery, if the ligaments have been severed there is no use in compounding the injury. I'm unsure if I can see a relationship between the issues I posted in regards to a clinical trial and the scenario you posted.

I am happy to walk away from the discussion.

Quote from: stephaniec on February 02, 2016, 02:25:47 AM
well to take a broad view and not to be sexist or anti woman or anything considered demeaning whitch I have absolutely no intention to do. Usually  one approaches living as a woman on the most basic and benign level as dressing as other woman dress which in and of itself leaves a lot of leeway . I mean on the most basic level any clothes whether be jeans or slacks that other woman purchase would suffice to fulfill any requirement as be perceive as dressing as the female as opposed to being dressed as a male even though many women blend clothing so in reality it really doesn't matter how one dresses to fulfill any clothing requirement . As far as other issues such as name change on documents and other legal means of existing within the framework of a specific gender if that's your purpose it seems only common sense if you want to be perceive by others as a specific gender .in which case what's the big deal of being perceive as that specific gender in order for the medical professional that's going to rearrange your genitals in order  for you to be perceived as that gender to try in the least offensive and least demeaning way to feel comfortable in surgically rearranging an organ that obviously plays an important individual and social role in your mental well being.

Now I have female Tom boyish friends who don't fit this. The whole notion of there being a female way of dressing is very much at odds with how society views women and very poor from a feminist perspective.

Quote from: Serenation on February 02, 2016, 03:02:24 AM
I'll define living as a woman, when you have to make a choice that says am I a man or a woman , you pick woman.

It doesn't need to be any more complicated than that.

Now this is a better definition, but how does a year spent ticking the 'f'  box have anything to do with preparing for surgery? How can ticking the 'f'  box be equated to having a real life experience?

Really there is no way of adequately defining rle.

The nearest I can come is with regards to HRT and there is no requirement for that.

Quote from: kira21 ♡♡♡ on February 02, 2016, 07:40:39 AM
Now I have female Tom boyish friends who don't fit this. The whole notion of there being a female way of dressing is very much at odds with how society views women and very poor from a feminist perspective.

Now this is a better definition, but how does a year spent ticking the 'f'  box have anything to do with preparing for surgery? How can ticking the 'f'  box be equated to having a real life experience?

Really there is no way of adequately defining rle.

The nearest I can come is with regards to HRT and there is no requirement for that.

well, the point being change the laws so the medical profession isn't held liable in any way for a person to walk into the operating room off the street and announce they want to change their sex organs to better fit an individuals perception of them selves no matter how vague their concept of gender is and how vague their understanding of the reason they need surgery to feel that can fit better into some vague notion of some undefined  notion of gender presentation. As it is now the medical community seems it necessary so people don't find themselves in the horrific state of having made a mistake. I'm not a doctor obviously , but if I was I sure as heck would not want to be responsible for not taking at least the most minimal precaution to ensure someone's continued mental well being.

Oh I would want to make sure I was doing to right thing too and an assessment like for other surgeries makes sense,  but rle doesn't exist unless you have strict definitions of how a woman should act and dress, which you shouldn't.

For me,  its a non issue,  I have a very femme appearance and I am post op,  but the concept of rle is a fallacy, as far as I am concerned.

Quote from: kira21 ♡♡♡ on February 02, 2016, 12:46:43 PM
Oh I would want to make sure I was doing to right thing too and an assessment like for other surgeries makes sense,  but rle doesn't exist unless you have strict definitions of how a woman should act and dress, which you shouldn't.

For me,  its a non issue,  I have a very femme appearance and I am post op,  but the concept of rle is a fallacy, as far as I am concerned.

Well, It's good your healthy and everything worked out.

I was confused by those saying a femme appearance was required for MtF surgery. It turns out WPATH SoC says nothing about that in Appendix C — Criteria for Genital Surgery.

Quote
Metoidioplasty or phalloplasty in FtM patients and vaginoplasty in MtF patients:
1. 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;
4. If signi cant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones);
6. 12 continuous months of living in a gender role that is congruent with their gender identity.

Although not an explicit criterion, it is recommended that these patients also have regular visits with a mental health or other medical professional.

The criterion noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity – is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery.

Here's the link http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf) to the SoC</a>

The relevant portion is on page 104.

According to the Standards of Care, there's nothing preventing you from "butching it up" if you're so inclined.

Hi,

I backtracked through WAPATH to the published literature source for the RLE requirement. 

Bockting, W.O. Psychotherapy and the real-life experience: from gender dichotomy to gender diversity, Sexologies, 17(4), 2008, 211-224......who, in turn, keeps referencing further back.....

However, there is little scientific rigor in the one-year cutoff.  However, the reasoning is better than I anticipated.  Below is the guts of the justification form the paper. 

Finding a comfortable gender role and expression The second phase of transgender-specific psychotherapy is more behavioral. The client is encouraged to connect with peers and find community on the Internet and in real life and
to experiment with various options of transgender expression. The goal is to explore to eventually find a gender role and expression that is most comfortable. Oftentimes, this phase involves giving adult clients permission to be a ''kid'' again and engage in adolescent developmental tasks (i.e., developing a sense of competence and  attractiveness in a more authentic gender role), yet not without losing sight of adult responsibilities (work, family) and appropriate interpersonal boundaries (Bockting and Coleman, 2007).

After a period of exploration and experimentation, most clients are ready to make a decision about a possible
gender—role transition and the available options of hormone therapy and/or surgery. Making a full-time gender—role transition is in essence the start of the RLE. Taking this step is terrifying for most clients. The goal of the RLE
remains to test the client's resolve and to prepare him or her for the implications of irreversible body modification
through surgery. Although the RLE no longer has to conform to a binary conceptualization of gender, clients
need to express their transgender identity in a way that is consistent with their long-term gender identification and
goals for expression. Hence, the therapist needs to help the client distinguish between gender ambiguity (e.g., bigender or gender-queer identity) and attempts to ''back into'' a gender—role transition out of fear of rejection (by family, friends, community, school or workplace). Making incremental changes without a thought—through plan, or assuming an ambiguous gender—role when the client's ultimate goal is a complete transition, may unnecessarily prolong anxiety. Rather, the client should take responsibility for the transition by planning it carefully in consultation with the therapist and peers (e.g., in group therapy). Appendices A, B and C provide examples of guidelines based on the WPATH standards of care for gender-identity disorders to evaluate the client's eligibility and readiness for hormone therapy and/or surgery (see also Bockting and Goldberg, 2006).

Hugs,

Jen

Quote from: suzifrommd on February 01, 2016, 06:15:19 PM
But shouldn't they be required to prove that RLE somehow contributes to that high rate of success?

So far, I've seen no such proof. On the contrary, all the evidence I've seen is that RLE has no relation to post-surgical satisfaction.

Proof would be so nice wouldn't it? But you know what? There is little to no proof that statins actually help prevent heart disease and how many decades have we been taking them to lower cholesterol? Wow, three questions in a row to answer a question. That must be a record for me.

Of course it would be a better argument if there were proof. We make it mainstream first and then the studies will come in from research students getting their thesis in med school. That's how it generally works. No one is going to pay to  have a study done like this.

Cindi

I don't know my brain could be damaged in some way for it to be like it is , but honestly I don't see the harm in it and it just makes sense. I might be delusional , but I honestly can't see why this is even an issue.

I always thought I would have to fit a certain mold to qualify for this RLE thing, but as it turned out I didn't even have to present as female. I just had to tell them I was. I guess it helped to have a sympathetic therapist that was cis female and dressed like a guy though.

I have mixed feelings on the requirement. Prior to starting the RLE, I thought it was the most ridiculous requirement ever. I thought it was a way of putting my life in danger for a year.

Now that I've started it, I feel like it really was a necessary step. There are so many things that I have to deal with that never even crossed my mind prior to starting it. I wanted HRT and surgery without the RLE because I was too afraid of what would happen if people knew I was trans. It never occurred to me that I'd have to go to a doctor's office and explain why I'm male with a vagina. Or that the hormones would change the way my face looked. Or that if I had to pee in a public location, that I would have to decide which bathroom to use on the spot. There are a lot of things I would have been blindsided by without the RLE. With it, I've been able to face each obstacle mostly one at a time.

That's not to say that I believe it should be a requirement because I still believe that it's my body, so it should be my decision. I just think it should be strongly suggested as a way to be sure, but not required.

I don't really know.  My mind says it's necessary and helps so many people.  I do know there has to be flexibility and a year is arbitrary. 

However....I had full FFS - brows, eyes, nose, jaw, Adams apple, cheek implants, lips and anything else needed to look like a woman.  (I was still swollen in my picture.) then, I went full time.  No way I will ever again look the way I did. 

Given the extent of FFS, would GCS have been that much different?  I asked in another topic.  The answer was about 50/50 yes and no.

I also know they waived RLE for me.  Psychs (three of them), surgeon (two) and insurance.  I just can't seem to get it done.  Something always blows up.

Be yourself, dress they way you want and have the genitals that fit you (as much as possible).  The rest is nothing. 

(Except where they still require RLE to get HRT - that's inhuman)   

Hugs,

Jen

Quote from: kira21 ♡♡♡ on February 02, 2016, 07:40:39 AM
Now I have female Tom boyish friends who don't fit this. The whole notion of there being a female way of dressing is very much at odds with how society views women and very poor from a feminist perspective.

Now this is a better definition, but how does a year spent ticking the 'f'  box have anything to do with preparing for surgery? How can ticking the 'f'  box be equated to having a real life experience?

Really there is no way of adequately defining rle.

The nearest I can come is with regards to HRT and there is no requirement for that.

I lived full time (voluntary) for a very long time before having SRS, I don't think RLE prepares you for surgery at all but I don't personally think it was intended to. That does not mean I think RLE is a bad thing.

Most people who have SRS will integrate into the pre-established laws and rules of a binary gender society. Why shouldn't people make an educated choice on that.

Quote from: AnonyMs on February 01, 2016, 09:11:57 AM
Divorce and career/money to name two.

We all wish transitioning had no negatives. Losing all of those things is something no one should have to go through, yet for so many of us it does.

For the sake of us all we need to make it so in the future families do not reject us, employee's do not reject us. Get rid of the stigma associated with being trans.

Quote from: Cindy on February 02, 2016, 12:38:10 AM
Since RLE has had good outcomes it would be unethical to set up a blind trial of X people in each group and see which ones had the 'best' outcomes

And that, my friends, is why RLE will be a requirement for all eternity. You may not like it, but it's not going away.

We've been fighting all our lives, internally anyway, at the injustice of having incongruent brains and genitals. We're hard wired/spring loaded (pick your favorite) to resist when gatekeepers place requirements on us that don't match our personal agenda, but RLE is part of the price of admission. We can rail against the tyranny, or we can take the less stressful path. Fighting it will only extend the time it takes to achieve congruence.

Rebellion feels good. Fighting for the cause that will set our sisters and brothers free is euphoric. But this isn't Star Wars and the Rebel Alliance ain't gonna destroy the Death Star.

I have severe body dysphoria, but no social dysphoria. Forcing me to do RLE makes no sense; it does nothing for me and delays the medical care I actually need. If they made, say, cancer patients do useless stuff for a year before getting medical care, there would be an uproar. I am horrified that nearly half of you support this.

Furthermore, I have extremely strong views against gender roles, I don't want to change my name, I don't care about what gender people perceive me as, and I won't even view myself as female until I finish transitioning. For me, being forced to do RLE would basically force me to pretend to be a vastly different person than I would be pre or post transition. It would be like having to volunteer for the Donald Trump campaign, and I hate Donald Trump.

The main thing I been reading is wanting to be a woman but live like the man you used to be..why bulk if you want to be a woman then rle should be a cakewalk..Rle was put in place for you to get comfortable in the role your going too live in for the remainder of your life. I'm a rarity for I need no hormones or surgery to look fem and it would be easy for me to go fulltime with no problems, my real rle is trying to be male which is much harder too do.

So if rle can mean presenting as anything, having experience of presenting as anything, what on earth does it actually mean and what could it's value possibly be?

Quote from: diane 2606 on February 02, 2016, 01:24:16 PM
I was confused by those saying a femme appearance was required for MtF surgery. It turns out WPATH SoC says nothing about that in Appendix C — Criteria for Genital Surgery.

Here's the link http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf) to the SoC</a>

The relevant portion is on page 104.

According to the Standards of Care, there's nothing preventing you from "butching it up" if you're so inclined.

In actuality though, it is in many places and by many therapists, used as a mechanism to force somebody to present as feminine, even if they are a tomboy, just to receive the go ahead.

Quote from: kira21 ♡♡♡ on February 03, 2016, 04:37:07 AM
So if rle can mean presenting as anything, having experience of presenting as anything, what on earth does it actually mean and what could it's value possibly be?

Based on all that I've seen and read, it is nothing more than an excuse for making trans people WAIT.

We're assumed not to know what shape our bodies should be, so the cisgender medical establishment demands we take a year to think about it so we won't make an awful mistake.

If cisgender people had to wait a year before their body could be made whole, I suspect the RLE requirement would be gone pretty quickly.

My problem with RLE is that it is not real at all.  Especially for the young, the basic reason for wanting to have the sexual organs of a different gender is to experience sex in that gender.  RLE, as now done, is demanding that you live life as a cross-dresser, not as a member of your chosen gender.  Demanding a year or more of enforced celibacy hardly seems ethical unless you are in a nunnery voluntarily.  Every choice that you make along the way in transition -- HRT, FFS, BA -- has lifelong consequences.  SRS has lifelong consequences also, but why should it be so different in terms of making an informed choice about it?

Half of the planet lives with one sex organ and half with the other.  Sure, some people might not be happy with their new organs, but they were not happy with their old organ either.  They are stuck and will be unhappy, but no worse off than someone who desperately wants to have that other sex organ.  At least they had the chance to give it a chance.  We all accept that every year after 14 reduces the chance of a good outcome with HRT.  Is it ethical to make someone wait a year or more for SRS, knowing that the eventual outcome will be worse as a result of that wait, as the unwanted hormones continue to do their work on your body?  No one is forcing anyone not to do RLE (if you think it as real life), and wait as long as you may wish for SRS, if at all.  But those who do wish to change their sex organs now should be able to do it now.  If they are legal age, and if not with parental per mission.  While HRT before SRS makes some sense, SRS followed by HRT will produce even better results with no need for blockers.  You are only young once.

As other have said, this is not personal; I already have mine.  But for the next generation, do we really want to extend the angst of their gender dysphoria by forcing them to wait for the medical procedures that will end it?  That sounds like cruel punishment to me.

If 95 percent are happy with their new gender choice and five percent are not, why should to dissatisfied five percent get to veto the joy of the other 95 percent?

Quote from: XKimX on February 07, 2016, 05:51:57 PM
the basic reason for wanting to have the sexual organs of a different gender is to experience sex in that gender.

Your assertion that the ability to have sex is the prime reason for surgery doesn't mesh with what I've heard from every transperson I've ever known, and I've known a few. The standards of care, which have always included a period of RLE, have existed since the dawn of medicalized transsexualism. Sex reassignment is about more than fornication; it's about living a lifetime.

You can rage against the system, but the only thing that will eliminate the requirement is overwhelming clinical data saying RLE is unnecessary. Good luck with that.

Quote from: diane 2606 on February 07, 2016, 10:11:40 PM
You can rage against the system, but the only thing that will eliminate the requirement is overwhelming clinical data saying RLE is unnecessary. Good luck with that.

Or the growing visibility and acceptance of non-binary trans people, or younger people having different attitudes to us older lot that seem predominant here, or people outside the USA and/or western culture.

I'd have added the growing acceptance of trans people in general, except a large portion of people here seem to be against it as well. I can't understand why so many trans people want to tell me how to live my life.

Quote from: AnonyMs on February 08, 2016, 03:59:54 AM
Or the growing visibility and acceptance of non-binary trans people, or younger people having different attitudes to us older lot that seem predominant here, or people outside the USA and/or western culture.

I'd have added the growing acceptance of trans people in general, except a large portion of people here seem to be against it as well. I can't understand why so many trans people want to tell me how to live my life.

Yes, this.

I disagree that it's impossible for transgender people to make our voices heard. I disagree strongly with the notion that there is no way for the medical establishment to treat us like competent adults. I'm at least not willing to cede the battle before we've even tried.

I personally think RLE is a good guideline, but since WPATH guidelines already generally require therapists to sign off on the procedure ususally I could see that being an acceptable gatekeeping mechanism in and of itself without the need for strict timelines....

Or perhaps keep the strict timeline and just have documentation of RLE in lieu of the hurdles of therapy, after all if someone has lived an entire year of their life in the target gender then surely they are commited to it I would imagine.

Of course you could just do both so that you require one ir the other.

I don't like anyone trying to dictate to me what is considered "real".

Second-guessing requirements like that reveal the disrespect the medical world has for any patient.
THEY want to be the 'gods' who decide what is "real".

All this having to ask authorities for "permission".
Who made them god?

You have this person asking you "are you sure? We don't think you know who you are, we think you are crazy, here, talk to this licenced professional for a while so we can verify our suspicions, we don't really believe you."

Quote from: suzifrommd on February 08, 2016, 05:00:55 AM
Yes, this.

I disagree that it's impossible for transgender people to make our voices heard. I disagree strongly with the notion that there is no way for the medical establishment to treat us like competent adults. I'm at least not willing to cede the battle before we've even tried.

The medical establishment (the instutions, not the actual doctors) treats ALL patients like children.
It is systemic. Collective arrogance. Since they have the force of government backing them up, they think they are gods.
It's not a battle, it's a war.
There is no surrender, their pyramid of power will crumble eventually.