Susan's Place Transgender Resources

 For myself and not others if they see things differently I would do therapy for a certain period because I personally need therapy for myself and it helps me. I do hormones by informed consent and I feel that's the way they should be done. GCS for myself personally I feel therapy has helped me see things that I need to be aware of to make a good decision on whether or not I should go through with it.  The RLE rule doesn't bother me in the least because I want to totally present as a woman , so the sooner the better. How do you think transition should  be done by the medical community.

Personally, I wish therapy had bigger emphasis and weight on the process one needs to go through before being approved for HRT. It literally took me maybe three visits, before I was given the letter for HRT. It's a problem with the American medical system in general; it is suffering from a "business/for-profit" model right now. I paid for the three therapy visits and thus there was *very* little gatekeeping for me, if at all.

I have learned about myself tremendously over transition. Transition has proven extremely difficult for me and I was not mentally prepared for the drastic changes one will essentially go through. That being said, although I believe transition has been an overall positive thing for me in the long-run, it was and is a journey littered with hardships, ruins, and nights and moments of feeling like giving up.

I wish I was forced to legally spend just a little more time in the therapy stage of things---it would have probably made transition a lot easier for me.

thanks

I completely disagree with Roni on this. The fact that you got hormones so quickly, as did I (within 2 visits) is hardly the standard. Most trans people need to spend months and even years, and far more visits to the therapists and doctors before they are allowed to start HRT. Quite frankly the current WPATH standards need to be updated I think. In my mind, things go a bit like this, and every thing related to the medical transition should be covered via insurance, with perhaps a limit on number of visits to the therapist for example.

I think therapy is a great first step for most people, but for me personally it wasn't, and I wouldn't have it required. I believe the informed consent model is the most fair, and logical solution, although I think a more detailed explanation of what will happen may be required. Hormones should then be allowed after consent via an endocrinologist, with regular blood draws every 6 months to 1 year. Bottom surgery/orchiectomy should be covered sometime after the first year or so, and should require some real life experience.

thanks for the honesty

Well then it probably points to a lack of a standard, golden rule on the length and leniency of therapy required. The fact that I was able to get on HRT so quickly while others can't just proves one thing: probably the need for a more consistent and standard approach to transition throughout the board in the medical community.

While some medical experts gatekeep transwomen far longer than required, only causing suffering and more pain for said women, some people fly by and for girls like me, are essentially left ill-prepared for the qualms of transition.

Conclusively, I guess just a more consistent way of going about transition. I no doubt would have loved to benefit from more legal therapy---definitely more than the three I was required---to be on the same level of preparedness that some women are given prior to transition.

I was in therapy for a little  less than 7 months before the notion popped into my head to try it. I was in therapy trying to figure out why I was in so much mental pain then I ended up in the psych ward on suicide watch and had a talk with the overnight psychiatrist and realized that the problem was me wanting to be female.

Quote from: in.Chains on January 06, 2016, 10:27:33 PM

I think therapy is a great first step for most people, but for me personally it wasn't, and I wouldn't have it required. I believe the informed consent model is the most fair, and logical solution, although I think a more detailed explanation of what will happen may be required. Hormones should then be allowed after consent via an endocrinologist, with regular blood draws every 6 months to 1 year. Bottom surgery/orchiectomy should be covered sometime after the first year or so, and should require some real life experience.

I agree with everything said here. Informed consent *is* the fairest. If certain women feel they are confident about their decision and do not need extensive therapy to become who they are, it is fair to let them proceed so long as they are informed and detailed about transition prior. It might have been the fault of my own therapist, or perhaps even me, maybe I said all the right things during therapy that made my therapist confident they didn't need to brief me of transition.. I just wish they were more hellbent in following the legal laws of having to provide information, because I didn't get much of it.

That's one thing that really upsets me. I feel the lack of information prevented me from stating many years earlier. I've been to a lot of therapy for other reasons which probably ultimately could be attributed to dysphoria , but wasn't. I'm  probably mostly to blame because I was so afraid to let the secret out, but if the possibilities were offered to me I would of gone for it.

Please return with me to 1988 (you'll probably wish you hadn't, but bear with me). I was in a new city and didn't know anyone other than those with whom I worked. One morning I was watching a local television show that had a physician (an M.D.) and his post-op patient. I called his office and made an appointment. When I got to his office, in boy-drag, we chatted for a moment or two, then he offered me a hormone prescription. Wha... Huh? All I was looking for was contact info for the support group, not life-changing pharmaceuticals. I told him I'd call back in a week, I needed to think about it. I did. He prescribed pills. I was off to the races.

I didn't begin therapy until I was about ready for RLE, almost six years (including a week in the hospital for blood clots caused by the pills). The doc prescribing the hormones was a G.P., not an endocrinologist. He neglected to inform me about the risks involved in taking first generation birth control pills. I didn't have much information, so my consent wasn't really informed, was it?

The psychologist I saw over the course of my transition was knowledgeable; she challenged me to think about things that would never have occurred to me until I was confronted by them, which I was. I survived because I was informed. My personal feeling is RLE is critical. If you haven't proven you can live day-in, day-out, in the gender you haven't previously lived a single day as for at least a solid year you're a candidate to become a statistic (and not in a good way). This comes with some caveats. If you don't need to earn a living, and there is no one depending on you for emotional or financial support, you can probably get by with a couple months.

In the end, it all worked out well for me. If I was designing a path to SRS I'd demand more time with a doctor who can explain the physiological risks and benefits of HRT, and the options (pills, injections, patches, implants, whatever). That's informed consent. I think an appropriately trained person, doesn't have to be a shrink, with whom someone contemplating SRS can get counseling from before RLE until past surgery would be the optimum. In the US, surgeons demand proof a candidate has been cleared by a therapist in order to prevent malpractice lawsuits; this isn't a bad idea.

The downside of everything I've written is that we're not all alike. MtF, or FtM, we all have similar stories, but each of us have different circumstances. Because we're dealing with medical procedures, we need medical people to provide us with the best medical information available, so we can make an informed consent. RLE is information gathering critical to that consent.

Now, go read something more fun.

thanks for sharing

Quote from: stephaniec on January 06, 2016, 11:12:22 PM
That's one thing that really upsets me. I feel the lack of information prevented me from stating many years earlier. I've been to a lot of therapy for other reasons which probably ultimately could be attributed to dysphoria , but wasn't. I'm  probably mostly to blame because I was so afraid to let the secret out, but if the possibilities were offered to me I would of gone for it.

That is my wish also: to have started younger, my ultimate wish being before puberty. I don't know if this is simply a case of never being happy with what I have around me or have achieved, but I always secretly wish that if I were to deal with being a trans woman all my life, I at least wish I had started transition a lot younger.... so I never developed certain masculine traits I have that HRT or surgery will never fix.

If we think about it though, mass information surrounding gender dysphoria has really only taken flight in the last decade or so, in both the medical community and general society. Maybe we have to accept that the possibility to have started sooner is simply impossible for the majority of us currently, but will thankfully be obtainable for new generations of people. I just think as the medical community and society continues to advance on the topic of gender dysphoria, how BEAUTIFUL it is going to be for trans kids of the future.

So I feel you on wishing to have started sooner, Stephanie. But I have accepted starting transition at the age of 21 was incredibly adventurous of me. I transitioned young, something a lot of transitioners cannot currently say, so I am on my way to being completely content with the stage I started transition. You're ever so lucky you've transitioned into a BEAUTIFUL, charming looking lady yourself!

thank you , My therapist told me I can't change the past, but I can make the most out of now and the future.

I also had three therapy visits over a five week period before I got my HRT letter.  However, in my case I thought that was enough.  At that point I was feeling desperate and if things had not been moving fairly quickly I likely would have restarted it anyway by mail order DIY.  Maybe some people do need more therapy at first and others do not.  At my first appointment I told my therapist that by my estimation I had already spent more than 12,000 hours thinking and reading on this subject over the course of many years.  Anyway, I was satisfied at that time that we had fully explored my particular issues which were primarily just determining to my satisfaction that I wasn't insane or something else along those lines.


Sent from my iPhone using Tapatalk

Six months later no step further
probably another 6-18 months before I see hormones

Informed consent, if only...

;_;

Quote from: Swayallday on January 07, 2016, 01:16:56 AM
Six months later no step further
probably another 6-18 months before I see hormones

Informed consent, if only...

;_;

as they say, Rome wasn't built in a day.

What I suggested was in my mind, the optimum general path. And it does follow the worldwide standard for trans health care, which is known as WPATH for those that don't know. I've read through it, and for the most part it's sound. I don't agree with RLE prior to hormones because many people couldn't pass anyway, and it's not right. That said, the average person should seek therapy before doing anything.

I chose informed consent, but I'm highly intelligent, educated, and have experienced dysphoria since I was a child. I see plenty of people who appear far more confused without much in the way of a brain proclaiming they're trans, and without dysphoria, and I just can't agree with handing them some hormones right away, which is why it's difficult to create a standard for everyone.

thanks for your thoughts

Quote from: stephaniec on January 07, 2016, 01:50:35 AM
as they say, Rome wasn't built in a day.

ayy some time does wonders

but not when you keep growing in a direction you dont want
especially when some features get more accentuated at this age
is just sad

plus i'll have to spam these forums for so long XD  ;D

I think informed consent for HRT. GRS should have to have some some therapy and RLE because it has the largest risks associated with it, also the person wanting surgery would have to be 10000% sure that they want such a life changing operation.

I would love to get surgery tomorrow, but I understand why RLE is necessary for it, its not something you want to regret. I do think that how much RLE someone has would vary surgery which is also why I think therapy would be required as to track how they coping with it.

 :police:
Okay folks. here is the thing. as long as this remains a civil and thoughtful discussion we will leave this thread open. As soon as it crosses any lines we will shut it down. Please keep all the TOS in mind especially TOS 5, 9, 10, and 15. Thanks
Mariah

I like the path that I am on. Informed consent for HRT with absolutely no therapy necessary and 1 year RLE minimum for GCS.

The reason for IC for HRT is that if you change your mind you can pretty much stop hormones early on with no drastic changes. Freeing one from the therapy requirement also allows people to see if HRT is for them and it is psychologically important because it gives you a sense that you've started transition without waiting for a letter. I think that gatekeeping at this stage is kind of pointless and harmful. IC is a harm reduction strategy as it can help discourage self-medicating or "DIY."

Therapy is important for many people because there are issues that need to be resolved for many trans women. Some can go without it. I've found it helpful. I wish I could afford to go more often.

GCS is irreversible so it makes sense to let people try out presenting female first because of the "measure twice, cut once" principle.

I believe that it should be 100% at your own discretion. Give me my prescription and a list of resources if I so choose.

RLE doesn't seem like a valid tool. Like saying I haven't been "living" before... I live how I want to live. Your idea of "real life" and mine may be very different. I may not ever want to "check" all the blocks... does that mean I'm not "living". RLE (to me)= I pay my bills and can handle my life.

Therapy isn't for everyone. It's only as effective as you want to believe it is.

SRS should be no different than any other elective surgery... it's like saying you need a therapist's letter for Breast Augmentation, or a Vasectomy, or nose job... imagine the public crying foul when they have to see a therapist before any and all elective surgery. Or a step further... see a therapist to get a letter for tattoos or piercings!

A guy turns himself into a lizard, another one turns himself into a cat with piercings and tattoos... and apparently transforming your body into a better looking feminine form is something that requires regulation... Hmmm... seems like there's a little more crazy out there than I thought.

In summary, I believe that everything should be available for everyone. Provide resources for them to utilize, or not... but definitely don't make it so difficult, or give it this horrible "Stigma".

Informed consent for HRT. Documented therapy and RLE for GCS, final judgement and recommendation by psychiatrists.

Preferably with a magic wand, but i do think therapy is important. Not so much to confirm one's gender, but to have help accessing supportive resources and have somebody to talk to about all the stuff one has to go through while transitioning. Its been a big help having somebody to go to for advice. Although I suppose some people do have supports in their every day lives as well and that works out fine for them. The people that I thought would have been the most supportive pretty much turned out to be opposite of what I had expected when I came out to them, though.

I think if you have a diagnosis for Gender identity disorder or Gender dysphoria from a psychiatrist you should be able to have access to HRT. There should not be long wait times on this. RLE should be something you have to do before SRS not before HRT and I agree with currently needed two psychiatric referrals for SRS, you should have to see them a certain amount of times, not just walk in a get something signed. I do think there should be a minimum time between initial diagnosis and SRS. I also think seeing a psychologist during transition should be an option available but not a requirement.

I like the way its happened for me. I had no intention of transition or had any thoughts about it . The process just unraveled itself as I was seeking help from preventing myself from saying goodbye. It just turned out good for me in that it just was a natural progression fro seeking help to having the path open up for me and moving along to where I feel quite good about what I'm doing. There's been no pressure and everything is in my  hands as to how I want to proceed.

Quote from: Harley Quinn on January 07, 2016, 12:06:56 PM
I believe that it should be 100% at your own discretion. Give me my prescription and a list of resources if I so choose.

RLE doesn't seem like a valid tool. Like saying I haven't been "living" before... I live how I want to live. Your idea of "real life" and mine may be very different. I may not ever want to "check" all the blocks... does that mean I'm not "living". RLE (to me)= I pay my bills and can handle my life.

Therapy isn't for everyone. It's only as effective as you want to believe it is.

SRS should be no different than any other elective surgery... it's like saying you need a therapist's letter for Breast Augmentation, or a Vasectomy, or nose job... imagine the public crying foul when they have to see a therapist before any and all elective surgery. Or a step further... see a therapist to get a letter for tattoos or piercings!

Well it's not so simple.

For cosmetic reasons you can sure get a BA. However for other reasons such as reconstruction after mastectomy due to cancer or some other disease you need certification. This is because someone else is likely paying for it, but it's because you need it.

Do we want to categorize our necessary surgeries in the same manner as cosmetic surgeries? People already say we are pretending. I'm not pretending and RLE is one tool to establish sincereness. It's not perfect but if there is a better means I'm all for it. Besides surgeons want you on hormones for a year anyway and most have waiting lists.

The other issue is who is paying. If it is being paid for by insurance or government subsidy then there may have to be a vetting process so that it isn't abused.

Also remember that WPATH SOC isn't law or regulation, it's a guideline that surgeons follow. They have to worry about insurance and malpractice lawsuits. Much of medicine is defensive, not just treatment for gender issues.

I'm torn. I honestly believe that many people are capable of knowing themselves and making these decisions without the input of a therapist or the trial of RLE. Those people shouldn't be stopped from pursuing their bliss with gates that only serve to confirm what they already know.

At the same time, it's a verifiable fact that some people are protected from hasty or uninformed decisions by the processes of therapy and RLE. There are people that undergo therapy or live through RLE, and find that transition is not the right option for them, or that a certain step in transition is not one they need or want.

Is it right to delay, possibly dangerously delay, the former to protect the later? Is it anymore right to expedite for the former at the expense of the later? 

I only know how my transition was supposed to be done.

Totally done by informed consent both GCS and HRT . No therapy or RLE required.

For me this is the fairest option with no doubt. Not everyone needs RLE nor therapy, and everyone should be granted access at their own will with no prior requirements, just informed consent.

Since you cant establish who may benefit/need from therapy or RLE and who may not, asking for any requirement is arbitrary and a potential loss of resources.

Quote from: Tamika OliviaIs it right to delay, possibly dangerously delay, the former to protect the later? Is it anymore right to expedite for the former at the expense of the later?

Is it right to delay anybody in their own benefit at the expense of restricting their own will over what to do with their bodies? It depends on where do you place the right to choose what you think is right for you.

Should be informed consent be more extensive, explanatory? Sure. Should be the transitioner adviced to ask for therapy? Sure. Required? Never. Should be adviced to ask for RLE? Sure. Required? Never.

Therapy should be available to everyone, but one should ask for it. If you don't ask for it, I think its not fair to blame on the doc or even on the system. You can ask them to inform yourself as much as they can, you can ask them to warn you about the lots of dificulties that transition implies, you can ask them to told you may need therapy and therapy may make some things easier for you. This is in the end just a very-well informed consent. You should be free to choose.

Quote from: iKatePeople already say we are pretending.

I'm glad they don't say I'm an android pretending to be a human. It'll be a long and boring existence of endless Touring tests :D

Now, seriously speaking, we shouldn't let uneducated people's foolness have that weight. They have the right to educate themselves.

Quote from: iKateThe other issue is who is paying. If it is being paid for by insurance or government subsidy then there may have to be a vetting process so that it isn't abused.

There's a nice point here. Had GCS/HRT services been proven abused anytime? In fact, can this be abused? The idea of those services being abused sounds really remote, but even if they could be abused, just diagnostic should be enough just when speaking about insurances and government.

All very interesting replies. The only thing I'm leery about and this is just me personally is straight out GCS with out any counseling. I could care less about RLE because I've been doing that for the most part since I was 4 years old. Hormones  most definitely done by informed consent . For me personally I like therapy so it's not a problem , but I understand others problem with it.

Quote from: Tamika Olivia on January 07, 2016, 08:47:39 PM
Is it right to delay, possibly dangerously delay, the former to protect the later?

Tamika, could you possibly explain what you mean by dangerously delay? I've been scratching my brain, since I first read your comment yesterday, trying to figure out how and why it would be dangerous for someone to not get SRS on demand.

I agree we're not all the same, so a one-size-fits-all approach isn't going to satisfy everyone's needs. But asking any competent, qualified surgeon to begin cutting before one has proven s/he is capable of functioning in society as the new gender is stretching what can reasonably be expected. Although I have no doubt you could find an unqualified moneygrubber who will promise to make your dreams come true, tomorrow, cash only, no questions asked; good luck to you. Those who say genital reconstruction is no different than asking for a nose job or breast augmentation miss the point. Those surgeries are minor. MtF SRS is a major, invasive medical procedure, and it will completely change one's life.

One other thing should be considered, many places in the US are working overtime to restrict a woman's right to do as she chooses with her body. Do you really think the society doing that is going to make it easy on you?

Quote from: diane 2606 on January 08, 2016, 08:04:43 PM
Those surgeries are minor. MtF SRS is a major, invasive medical procedure, and it will completely change one's life.

So, may we go on with that criteria and conclude that an extensive and aggresive FFS + BA could be a major and invasive medical procedure that can change completely your life?

Quote from: diane 2606Please check your male privileges at the door.

Right to freedom of choice just in my pocket  :D Sometimes I forget I'm a woman, lol, could that make me not to qualify? :D

Quote from: Wednesday on January 08, 2016, 10:14:29 PM
So, may we go on with that criteria and conclude that an extensive and aggresive FFS + BA could be a major and invasive medical procedure that can change completely your life?

You'll find this hard to believe, but I don't have a clue what you're talking about?

Quote from: Wednesday on January 08, 2016, 10:14:29 PM
Right to freedom of choice just in my pocket  :D Sometimes I forget I'm a woman, lol, could that make me not to qualify? :D

I suppose it depends which state you live in, doesn't it?

I am all in for the informed consent thing at least where the system can not process the demand effectively. For HRT. If one has to wait six months or up to three years [1] (http://attitude.co.uk/three-year-waiting-list-for-gender-identity-patients/) to get first appointment with an imposed therapist, the system is doing it very wrong. For what it is worth, reaching the first appointment means one appointment every month or such. Not every week, as it is available in the US.

Personally, when requiring of me to go through a therapist, I want the option to go private, choose who I talk to, have appointment within three weeks and then every week. That simply doesn't exist here, per every point named. So, the fairest thing to do will be to allow signing a doc to get an appointment with endo, and not in matter of months please.

Quote from: diane 2606You'll find this hard to believe, but I don't have a clue what you're talking about?

What I was talking about is: Where do you exactly place the point to establish when therapy/RLE is needed for a surgical procedure?

Full Facial Feminization Surgery is a very major, invasive, drastic procedure (and oftenly faces can't simply be restored to the initial point) but therapy/RLE are not required for it. Same for other procedures. In fact you can go for Full Facial Surgery and Breast Augmentation in one shot, and no therapy/RLE.

So, where do you place the point?

Quote from: Wednesday on January 08, 2016, 05:15:24 PM


There's a nice point here. Had GCS/HRT services been proven abused anytime? In fact, can this be abused? The idea of those services being abused sounds really remote, but even if they could be abused, just diagnostic should be enough just when speaking about insurances and government.

Insurance basically forces the RLT requirement and even things that are available on demand usually have certification required. For example my insurance would not cover more than 1mg estradiol without pre certification. Gender dysphoria is a valid reason. The idea is to pay for medically necessary things not just what you desire. Insurance is about making you whole after a loss, not simply funding everything you want. Otherwise insurance couldn't exist.

But I could pay for it myself without any certification.

As I said the RLT is the currently accepted diagnostic. They may make exceptions for those who are suffering extreme gender dysphoria such as people attempting to cut their genitals off. If there was a better way to weed out abuse and fraud I would be all for it.

Quote from: Martine A. on January 09, 2016, 12:17:01 AM
I am all in for the informed consent thing at least where the system can not process the demand effectively. For HRT. If one has to wait six months or up to three years [1] (http://attitude.co.uk/three-year-waiting-list-for-gender-identity-patients/) to get first appointment with an imposed therapist, the system is doing it very wrong. For what it is worth, reaching the first appointment means one appointment every month or such. Not every week, as it is available in the US.

Personally, when requiring of me to go through a therapist, I want the option to go private, choose who I talk to, have appointment within three weeks and then every week. That simply doesn't exist here, per every point named. So, the fairest thing to do will be to allow signing a doc to get an appointment with endo, and not in matter of months please.

Do you have any option to go private at all there?

We don't have nationalized healthcare here which is why we aren't basically forced to wait.

I can only speak for myself. But I'm 44 now, have lived with my gender identity for the last 37 years, am mentally stable, raised a son and own a small business. I'm a big girl, know exactly what I'm doing and actually feel patronized and disempowered having to wait over a year before I can even start with HRT. Subjecting myself to this awful process is the only way I can transition, otherwise my medical insurance won't pay for it.

I feel I deserve to just get my treatment if I indicate that's what I need. Gender dysphoria is basically a self diagnosis and I often experience even having to explain myself as intrusive to my personal privacy. All these questions I have to answer about my sexuality and personal life to some psychologist who just came out of college, the way in which a family member or close friend needs to come and talk about me as well, it's an insult to me.

I just go along with it because it's the only way. Just give me my hormones already.

Quote from: iKate on January 09, 2016, 06:01:54 AM
Do you have any option to go private at all there?

We don't have nationalized healthcare here which is why we aren't basically forced to wait.

N-ope. No private health care here. And meds are under strict control. People still self-medicate, but the tunnels for that are unknown to me. I could even get myself a good endo outside the country if I knew were to get the meds from.

Quote from: Wednesday on January 09, 2016, 12:51:12 AM
What I was talking about is: Where do you exactly place the point to establish when therapy/RLE is needed for a surgical procedure?

Full Facial Feminization Surgery is a very major, invasive, drastic procedure (and oftenly faces can't simply be restored to the initial point) but therapy/RLE are not required for it. Same for other procedures. In fact you can go for Full Facial Surgery and Breast Augmentation in one shot, and no therapy/RLE.

Facial feminization surgery and breast augmentation are elective cosmetic surgeries, whether we like that fact or not. Genital reconstruction is not a cosmetic surgery.

Quote from: Wednesday on January 09, 2016, 12:51:12 AM
So, where do you place the point?

You don't need any therapy or RLE if you choose to have full facial tatoo and hundred spikes out of your face. If you don't need therapy for that, you also shouldn't need therapy and RLE for faaaaaaar less dramatic and drastic facial feminization surgery. Although it can be life changing procedure it can't even compare with the life changing permanent effects of having dragon drawn all over your face, demon horns implants and metal spikes through your eyelids, nose and lips.

Quote from: in.Chains on January 06, 2016, 10:27:33 PM
I completely disagree with Roni on this. The fact that you got hormones so quickly, as did I (within 2 visits) is hardly the standard. Most trans people need to spend months and even years, and far more visits to the therapists and doctors before they are allowed to start HRT. Quite frankly the current WPATH standards need to be updated I think. In my mind, things go a bit like this, and every thing related to the medical transition should be covered via insurance, with perhaps a limit on number of visits to the therapist for example.

I think therapy is a great first step for most people, but for me personally it wasn't, and I wouldn't have it required. I believe the informed consent model is the most fair, and logical solution, although I think a more detailed explanation of what will happen may be required. Hormones should then be allowed after consent via an endocrinologist, with regular blood draws every 6 months to 1 year. Bottom surgery/orchiectomy should be covered sometime after the first year or so, and should require some real life experience.

The WPATH Standards of Care have been updated and there's no requirement for therapy before HRT or SRS. See version 7

Page 28 "Psychotherapy Is Not an Absolute Requirement for Hormone Therapy and Surgery"

Page 33 on the detailed criteria for HRT does not require therapy. It does require "A referral is required from the mental health professional who performed the assessment, unless the assessment was done by a hormone provider who is also qualified in this area.", which is essentially medical informed consent (SOC doesn't call this informed consent and discusses that model as a different thing).

Informed consent for HRT is usually taken to mean you ask for HRT and the doctor just gives it to you, but its not the medical definition. There's no checking that you're capable of consenting, which is what a psych should do.

Page 105 is the criteria for SRS, and it has no requirement for therapy either, just the addition of RLE to the detailed requirements. I'm a case where this is not suitable, and I disagree with the SOC on this.

I think informed consent for HRT and SRS is the correct model, with consent having the medial meaning. And sue any doctor that falsely says you're not capable of consent.

The SOC is not a law, and there are a few people who've had SRS without RLE. I can't say I've ever heard of anyone doing that and regretting it, but the numbers are very small.

I don't  really know how it "should be", but I'm glad that I'm seeing a therapist.  It's been very helpful for someone as insecure as I am.  I'm taking my time and moving forward at the pace I feel comfortable in and talking my concerns out and getting guidence through each step.  So I'm very pro therapy. However, I don't know how I feel about people beibg forced into therapy in order to transition.  In my opinion people have the right to do what they want with their own bodies and have the right to live as they choose.  If we aren't hurting anyone, why shoulf it matter to anyone else?  Then at the same time I think havinf safeguards can protect some people from taking a permanent and drastic that they may not have really wanted in the end.   Considering that detransitioning does happen from time to time, it could might prevent those few cases.  So I'm mixed on this. 

@Learningtolive

If someone indicates they could use some therapy and guidance, they should obviously be provided with that. I wonder however, if the people detransitioning didn't get any therapy. It's not like therapy would prevent people from making the wrong choices.

I saw a therapist for a year before deciding to start HRT. At the end of it I started and I didn't ask for permission (letters). It was enough to know my own mind.

If you need therapy you should do it. Otherwise don't, but it shouldn't be a condition of getting it. It disrupts the theraputic relationship with them holding it over you. I told my psych that I'd be open with him about everything, and that if I ever asked for SRS letters and he didn't give it to me I'd just arrange it elsewhere. I think being honest helped me get the help I needed.

Quote from: AnonyMs on January 09, 2016, 10:05:38 AM
If you need therapy you should do it. Otherwise don't, but it shouldn't be a condition of getting it. It disrupts the theraputic relationship with them holding it over you. I told my psych that I'd be open with him about everything, and that if I ever asked for SRS letters and he didn't give it to me I'd just arrange it elsewhere. I think being honest helped me get the help I needed.

Exactly. It is perceived as a power game when they are the ones to say yes, no or not now. Assumed the trans person is shouting 'yes' repeatedly.

I agree that you need to trust your therapist wholeheartedly.   My therapist is probably the only person I could ever fully open up to because I knew that she was non judgemental and has a lot of history working with the trans community.  Unfortunately, not all of us can be so lucky to have that as many just label us as crazy.  It's really a tricky subject when so few people are educated on the topic and even many therapists are ignorant regarding the trans community.  And even the most ignorant people already have a strong opinion about us without really fully understanding the issue.  That's why I'm torn.  That and I do believe it's no one else's business what someone does with their life or body as long as they aren't hurtinf anyone.  That being said I still remain very pro therapy, you just need to find one you trust and feel comfortable with.

Quote from: Ltl89 on January 09, 2016, 12:17:39 PM
I agree that you need to trust your therapist wholeheartedly.

My first therapist never knew who I was. I saw her for a year.

My second did, and I stopped going. I'd have gone longer, but he knew who I was.

My 3rd was my psych, and I was a bit desperate, so he knew who I was.

I don't know how I'd have managed if I needed letters from any of these people. I always arranged to get around it before seeing them so I'd feel safe.

Sounds nuts, I know.

Quote from: AnonyMs on January 09, 2016, 07:56:10 AM
The WPATH Standards of Care have been updated and there's no requirement for therapy before HRT or SRS. See version 7

Page 28 "Psychotherapy Is Not an Absolute Requirement for Hormone Therapy and Surgery"

Page 33 on the detailed criteria for HRT does not require therapy. It does require "A referral is required from the mental health professional who performed the assessment, unless the assessment was done by a hormone provider who is also qualified in this area.", which is essentially medical informed consent (SOC doesn't call this informed consent and discusses that model as a different thing).

I am afraid this is open for interpretations enough to stall us as much as they presently are. Further in text they explain while psychotherapy is not needed, screening/assessment of mental health is. There we go. Unfortunately, that is how things work here.

Quote from: Martine A. on January 09, 2016, 10:51:52 PM
I am afraid this is open for interpretations enough to stall us as much as they presently are. Further in text they explain while psychotherapy is not needed, screening/assessment of mental health is. There we go. Unfortunately, that is how things work here.

There's no need to interpretation. No doctor has to follow WPATH, and there's not a lot you can do about it apart from find a different one. On the positive side that means you don't have to follow WPATH yourself (or myself as the case may be), and can do what you want if you can shop around a bit.

I believe the screening/mental is supposed to be informed consent. If you are capable of consent then you can do it and they can't stop you.

I came across this today on another forum. It looks like they are suggesting a more flexible approach for surgery.

New Criteria for Sex Reassignment Surgery: WPATH Standards of Care, Version 7, Revisited
http://www.tandfonline.com/doi/full/10.1080/15532739.2015.1081086

thanks for the info

Quote from: AnonyMs on January 29, 2016, 12:47:12 AM

Quote from: Martine A. on January 09, 2016, 10:51:52 PM
I am afraid this is open for interpretations enough to stall us as much as they presently are. Further in text they explain while psychotherapy is not needed, screening/assessment of mental health is. There we go. Unfortunately, that is how things work here.

There's no need to interpretation. No doctor has to follow WPATH, and there's not a lot you can do about it apart from find a different one. On the positive side that means you don't have to follow WPATH yourself (or myself as the case may be), and can do what you want if you can shop around a bit.

I believe the screening/mental is supposed to be informed consent. If you are capable of consent then you can do it and they can't stop you.

I came across this today on another forum. It looks like they are suggesting a more flexible approach for surgery.

New Criteria for Sex Reassignment Surgery: WPATH Standards of Care, Version 7, Revisited
http://www.tandfonline.com/doi/full/10.1080/15532739.2015.1081086

Link doesn't work, the site is down for maintenance. We have version 7 of the SOC right here in the wiki, though.

https://www.susans.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People

Hugs, Devlyn

Quote from: Devlyn Marie on January 29, 2016, 10:45:05 AM
Link doesn't work, the site is down for maintenance. We have version 7 of the SOC right here in the wiki, though.

https://www.susans.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People

Hugs, Devlyn

The site seems to be back.

Its not the SOC but a new paper arguing for changes in the next version

ABSTRACT
The WPATH Standards of Care (SOC) Revision Committee are reassessing criteria for sex reassignment surgery. The major points of discussion for which WPATH might provide additional guidelines are: (1) gender binary defying surgery, (2) gonad retention for fertility preservation prior to hysterectomy in transmen and castration (+ vaginoplasty) in transwomen, (3) the necessity for two referrals from qualified mental health professionals who have independently assessed the patients, prior to performing genital surgery, especially for hysterectomy and salpingo-oophorectomy, (4) the minimum age of 18 as eligibility to undergo irreversible (genital) surgery procedures. We have performed a literature search focussing on these subjects in order to formulate a supported opinion for changing the SOC regarding these topics.

I believe you should get hrt with informed consent,grs on the other hand I believe in rle,i've known a couple of trans who transitioned without rle and regretted it. To me if you want to be female or male you should start living that role to see if it's what you want and to get comfortable in that role before surgery. I for one like both roles and am comfortable in both modes,since I'm both male and female .