What is the GRS referral criteria in the U.S.A?
I live in the U.K and although I have been living and working as a female for over 5 years, changed all my documentation (2003) I have been unable to get a referral.
Would it be easier for me to travel to the U.S.A or another country to get a referral?
Quote from: Berliegh on November 21, 2007, 12:20:23 PM
What is the GRS referral criteria in the U.S.A?
I live in the U.K and although I have been living and working as a female for over 5 years, changed all my documentation (2003) I have been unable to get a referral.
Would it be easier for me to travel to the U.S.A or another country to get a referral?
Each surgeon has their own requirements, though they tend to generally follow the Standards Of Care.
You can email Brassard and/or Bowers and they'll email you their requirements. I don't know about the others.
~Kate~
Quote from: Kate on November 21, 2007, 12:44:30 PM
Quote from: Berliegh on November 21, 2007, 12:20:23 PM
What is the GRS referral criteria in the U.S.A?
I live in the U.K and although I have been living and working as a female for over 5 years, changed all my documentation (2003) I have been unable to get a referral.
Would it be easier for me to travel to the U.S.A or another country to get a referral?
Each surgeon has their own requirements, though they tend to generally follow the Standards Of Care.
You can email Brassard and/or Bowers and they'll email you their requirements. I don't know about the others.
~Kate~
Thanks Kate.....I too follow the HBSOC...but it hasn't helped me so far in getting a referral?
You pretty much only need one year RLE, two letters from therepists and some like you to have been on HRT for a year at least.
1. A letter from a therapist.
2. A letter from an MD or Ph.D. of Psychology. Some people do use their endo for the second letter and some surgeons accept this.
You might want to go through your personal history, the SoC are not manditory in all cases and surgeons are known to make exceptions for certain foreign patients. From what I noticed, the NHS does not really get the SoC at all and is stuck in the dark ages with regards to these issues.
Many surgeons skip the second letter by a psychiactrist and will except the second one from a theripist or gender specialist... last time I checked this was the case with Dr Bowers.
So Gabrielle was pretty much on the dot... But really the SOC is just a guideline and its up to the operating surgeon as to how they follow it.
Quote from: Gabrielle on November 21, 2007, 06:19:20 PM
You pretty much only need one year RLE, two letters from therepists and some like you to have been on HRT for a year at least.
I've been on hormones for about 10 years and have completed 5 years RLT. in the U.K you need two NHS referrals from two psychiatrists to get a referral for GRS. So far I have been turned down for a referral in London but they would not provide me with an answer?
I have complied with all protocols but I am still without a referral. It looks like it is much easier in the U.S to get a referral?
What is the difference between therepists and psychiatrists?
Quote from: Berliegh on November 22, 2007, 07:24:05 AM
Quote from: Gabrielle on November 21, 2007, 06:19:20 PM
You pretty much only need one year RLE, two letters from therepists and some like you to have been on HRT for a year at least.
I've been on hormones for about 10 years and have completed 5 years RLT. in the U.K you need two NHS referrals from two psychiatrists to get a referral for GRS. So far I have been turned down for a referral in London but they would not provide mr with an answer?
I have complied with all protocols but I am still without a referral. It looks like it is much easier in the U.S to get a referral?
What is the difference between therepists and psychiatrists?
A therepist has a Masters or PhD in psychology where a psychiatrist has a Medical Degree also and can prescribe medications. Mine has a PhD and so I go to a Endo for my medication.
Quote from: Berliegh on November 22, 2007, 07:24:05 AM
What is the difference between therepists and psychiatrists?
From the SOC:
If the first letter is from a person with a master's degree, the second letter should be from a psychiatrist or a Ph.D. clinical psychologist, who can be expected to adequately evaluate co-morbid psychiatric conditions.I think the idea is that a psych can medically diagnose mental problems which might cause concern.
~Kate~
Quote from: Kate on November 22, 2007, 09:23:33 AM
I think the idea is that a psych can medically diagnose mental problems which might cause concern.
I think it also has to do with making sure that there isn't something that was overlooked in the diagnosis. Healthcare is an imperfect science and mistakes get made.
It has to do with the gatekeeper mentality established to limit the number of transsexuals offending the sensibilities of the public, a large portion of which have gender issues themselves, especially men.
Quote from: melissa90299 on November 22, 2007, 10:35:31 AM
It has to do with the gatekeeper mentality established to limit the number of transsexuals offending the sensibilities of the public, a large portion of which have gender issues themselves, especially men.
No, I don't think so. It has to do with surgeons protecting themselves from being sued by people who go
"oops!" later on. If the surgeon can say,
"well look here, this person was *medically diagnosed* as being both GID and stable," it helps protect the surgeon from liability.
~Kate~
Thanks everyone for the all the information........
I'm just getting serously worried about the timescale in which my transition is taking......(now we are back to the early v late transition topic).....
I seriously thought it would be an 18 month programe and not a 10 year fight with the U.K system....
By rights I should have been finished by 2001...
There's no reason to have to fight like you have been. In the US we do not have nationalized health care. You can have your options, you can choose what you want to do. Just come over and be done with it if you want to.
Then just get on with life. ;)
Quote from: Berliegh on November 22, 2007, 10:47:38 AM
I seriously thought it would be an 18 month programe and not a 10 year fight with the U.K system....
My rights I should have been finished by 2001...
Well, what are you willing to do? If you're willing to use a surgeon in North America, perhaps contact them, tell them your story, and see what they say? Officially, it seems every surgeon here wants those two letters as well as a year of RLT. But from what I'm seeing on forums and real life, those "rules" don't seem very strict.
If you want referrals from US therapists/psychs though, I have no idea how you could arrange that unless you travel here? In theory, it takes many, many sessions to get a SRS letter. But perhaps a therapist and psych sympathetic to your story will waive some of those requirements? Maybe, as with a surgeon, the idea is to start contacting as many as you can, explain your situation, and see how they respond?
~Kate~
Quote from: Cire on November 22, 2007, 10:55:25 AM
There's no reason to have to fight like you have been. In the US we do not have nationalized health care. You can have your options, you can choose what you want to do. Just come over and be done with it if you want to.
Then just get on with life. ;)
I agree, we have a NHS health System that we pay the majority of our taxes towards and it is suppost to support us when we need it but when you are faced with the situation of needing treatment the system isn't there. Any treatment I have had has been through private channels which I shelled out for and not through the NHS. I have never been able to access treatment for gender dysphoria through the U.K NHS system..
In the U.K it's like a lottery system and some parts are better than others depending on where you live....Scotland seems to be the best place to live if you have gender dysphoria...
Quote from: Kate on November 22, 2007, 10:46:35 AM
Quote from: melissa90299 on November 22, 2007, 10:35:31 AM
It has to do with the gatekeeper mentality established to limit the number of transsexuals offending the sensibilities of the public, a large portion of which have gender issues themselves, especially men.
No, I don't think so. It has to do with surgeons protecting themselves from being sued by people who go "oops!" later on. If the surgeon can say, "well look here, this person was *medically diagnosed* as being both GID and stable," it helps protect the surgeon from liability.
~Kate~
How many surgeons have been sued for malpractice for a successfully completed SRS?
Quote from: melissa90299 on November 22, 2007, 11:37:45 AM
Quote from: Kate on November 22, 2007, 10:46:35 AM
Quote from: melissa90299 on November 22, 2007, 10:35:31 AM
It has to do with the gatekeeper mentality established to limit the number of transsexuals offending the sensibilities of the public, a large portion of which have gender issues themselves, especially men.
No, I don't think so. It has to do with surgeons protecting themselves from being sued by people who go "oops!" later on. If the surgeon can say, "well look here, this person was *medically diagnosed* as being both GID and stable," it helps protect the surgeon from liability.
~Kate~
How many surgeons have been sued for malpractice for a successfully completed SRS?
How many psychiatrists have been sued for blocking referrals?
Hi,
How about asking them for a letter stating information on you. Time spent in therapy, time started hormones, etc, etc, etc. The letter could have impact in one of two ways. First they will think you are lining them up for a lawsuit, and will grant your GRS :). If not, You might be able to use this as a way to get a referal with only a couple of hours with someone to confirm what the letter and you are saying.
I had done the 3 months required and had 1 letter. Fastforward 4 years I needed the second letter and sent the information to someone, made a app and got "rubber stamped" for the second letter. The person had met me a couple of times prior, as a friend had went there, and I went along for the ride. If you have contacts in the U.S or Canada perhaps they know friendly and sympathic doctors willing to do this. Letters from a couple of friends about you also. Theres some logistics to work out, but it could work. It's not like your doing something wrong, you just want to get out of limbo.
Jennifer
Quote from: Kate on November 22, 2007, 10:57:25 AM
Quote from: Berliegh on November 22, 2007, 10:47:38 AM
I seriously thought it would be an 18 month programe and not a 10 year fight with the U.K system....
My rights I should have been finished by 2001...
Well, what are you willing to do? If you're willing to use a surgeon in North America, perhaps contact them, tell them your story, and see what they say? Officially, it seems every surgeon here wants those two letters as well as a year of RLT. But from what I'm seeing on forums and real life, those "rules" don't seem very strict.
If you want referrals from US therapists/psychs though, I have no idea how you could arrange that unless you travel here? In theory, it takes many, many sessions to get a SRS letter. But perhaps a therapist and psych sympathetic to your story will waive some of those requirements? Maybe, as with a surgeon, the idea is to start contacting as many as you can, explain your situation, and see how they respond?
~Kate~
Several will do work over the phone and will write referrals. I know mine will. So that is an option for her.
I'm Swiss but will have GRS in July 2008 with Dr. Bowers, she requires two psychiatric evaluations, usually by a psychologist or psychiatrist. She also has other requirements for surgery, e.g. an HIV test, complete medical records, not smoking & a healthy weight to avoid complications post-GRS.
Quote from: Blanche on November 23, 2007, 03:15:27 AM
I'm Swiss but will have GRS in July 2008 with Dr. Bowers, she requires two psychiatric evaluations, usually by a psychologist or psychiatrist. She also has other requirements for surgery, e.g. an HIV test, complete medical records, not smoking & a healthy weight to avoid complications post-GRS.
That's the problem I have over here in the U.K, I have been trying to get two referrals for the last 5 years. The main problem is the time frame between appointments (one every 6 months) and it could take anything up to 10 years if you end up having to go through a new attachment with the NHS. I know I will have to get out of the U.K if I want to progress with my transition..
Suporn has varies requirements depending on age.
He also has a associate Physchaiatrist who can evaluate patients on arrival.
I suggest you look at the requirements on his web site.
Rebecca
My American therapist keeps telling me of a stipulation I haven't come across anywhere else!
He says I have to divorce before he'll write the letter. Either that, or have my wife sign a statement that she doesn't object to my surgery. This has nothing to do with my qualifications and everything to do with covering his own ass.
Quote from: Hypatia on November 23, 2007, 12:33:02 PM
My American therapist keeps telling me of a stipulation I haven't come across anywhere else!
He says I have to divorce before he'll write the letter. Either that, or have my wife sign a statement that she doesn't object to my surgery. This has nothing to do with my qualifications and everything to do with covering his own ass.
That SHOULDN'T be a requirement at all. It has nothing to do with him covering his own ass either. That is something he shouldn't be requiring at all. Its a very archaic demand.
In Virginia a divorce is forced anyway with sex change.
Quote from: Hypatia on November 23, 2007, 12:33:02 PM
My American therapist keeps telling me of a stipulation I haven't come across anywhere else!
He says I have to divorce before he'll write the letter. Either that, or have my wife sign a statement that she doesn't object to my surgery. This has nothing to do with my qualifications and everything to do with covering his own ass.
That's an extremely antiquated viewpoint. It used to be common that a person desiring SRS would have to get a divorce before surgery, but I haven't heard of anyone suggesting such a thing in many years. I'd find another therapist if at all possible.
y2g
If the therapist is good, if that person has helped you, what's your issue with helping him not get sued?
A simple letter is all that is needed.
Quote from: Hypatia on November 23, 2007, 12:33:02 PM
He says I have to divorce before he'll write the letter. Either that, or have my wife sign a statement that she doesn't object to my surgery.
Check out the
EVALUATION AND DIAGNOSIS section in our resources article
STANDARDS OF CARE AND HORMONE THERAPY FOR TRANSSEXUALS: ISSUES AND CONSIDERATIONS (https://www.susans.org/reference/hormones/hormonek.html)
I've heard of it being a requirement in the distant past, but rarely hear of it these days. According to
"True Selves," transsexuals were once urged to move away and never contact their children again too.
Although, I must admit that I'm convinced that my own therapist is waiting for me to "resolve" my marriage as well. And to be fair, I'll admit that two heterosexual women being married isn't exactly the optimal relationship. But it is what it is, and while we would never enter into such a relationship NOW, knowing what we know, ending an existing relationship isn't quite so simple a decision.
~Kate~
Quote from: y2gender on November 23, 2007, 03:26:25 PM
Quote from: Hypatia on November 23, 2007, 12:33:02 PM
My American therapist keeps telling me of a stipulation I haven't come across anywhere else!
He says I have to divorce before he'll write the letter. Either that, or have my wife sign a statement that she doesn't object to my surgery. This has nothing to do with my qualifications and everything to do with covering his own ass.
That's an extremely antiquated viewpoint. It used to be common that a person desiring SRS would have to get a divorce before surgery, but I haven't heard of anyone suggesting such a thing in many years. I'd find another therapist if at all possible.
y2g
To say its antiquated is an understatement, that was one of the problems with what is now considered the bad old days. I have not heard a therapist requiring this in a long time. I know the therapist you are seeing and that is VERY problematic viewpoint for him to have in this day and age. It should not even come up.
Also Bowers does not require two Doctors. She follows the standards of care, it could be a LCSW and a Doctor (Ph.D, Psy.D. or MD). I know this because one of my friends who is seeing Bowers two letters came from a LCSW.
Quote from: Amy T. on November 23, 2007, 02:30:45 PM
In Virginia a divorce is forced anyway with sex change.
I hadn't heard that. Who or what implements this divorce-forcing, and by what means? (and by what
right?)
Posted on: November 23, 2007, 10:03:33 PM
Quote from: Amy T. on November 23, 2007, 08:04:31 PMI know the therapist you are seeing and that is VERY problematic viewpoint for him to have in this day and age. It should not even come up.
Yeah, he's a good guy in all other respects, so I'm awfully conflicted. It's kind of late in the game for me to switch therapists now. I'm wondering how to handle this now because my surgery is finally on the horizon.
The information I'm getting here that he's out of line is very valuable to me. To run statements through the communal bull->-bleeped-<--meter and verify for truth. He told me explicitly that it's to guarantee that he doesn't get sued by angry spouses. He also insisted to me that all surgeons will demand this as a prerequisite--I think he even said Thai surgeons require it.
He is way off base with regards to this. No surgeon has it as a pre-requisite. End of story. Years and years ago this was the case, but no longer. Like it was said, very antiquated thinking.
The court voids the marriage by the way. Thats what you heard right VOIDS. No two people of the same sex can be married in Virginia.
They view marriage the same way in the U.K. If you are still married you need to get consent from your wife..
That isn't my problem as I've never had a wife. I have complied with all the protocols including 5 years RLT but I still cannot get a referral for GRS in the U.K...