Hola ya'all!

I've been told that the transition system in the Netherlands is pretty good and thorough. After talking to a fellow trans person from England, I could already detect many differences, which made me wonder. How is the transitionprocess for you guys in different countries?

For Holland, it's pretty straightforward. We have two special hospitals with a gender department. If you're trans, that's the place to go. I could go there without a doctor's appointment.
When you get there, you do have to wait for a long while for your first appointment. I had to wait 3 months because the teams are small and thete are seemingly many people with gender issues. After that wait, you have an initial talk with a psychologist to see if you are eligible for their genderteam, or if there might be something else going on with you.

After you get a pass, you have to wait for another year before you enter the diagnostic phase. In this phase you'll have deep talks with psychologists to see what is happening in your life, and what your problems are. The talks are not only to see if your genderissue is 'real', but also to see if you have the support in your family/friends that you need for such a hard process.

That phase takes about 6 months. After that, if you pass again, you will be given hormones. 3 months after starting hormones, you have to start the real life phase. This means that you have to start living as the gender you truly are on a full time basis.

About a year later, while you keep on seeing your psychologist about every 3 months, you can enter the surgery phase.

So, what about you guys? Is it similar or very different for you?

I am glad you made this thread - the process for transitioning in different countries is interesting to me.

In the pacific NW United States -  no waiting, mental health checks, or steps to take- but we pay for everything in most cases.  Therapy is not required for hormones - several doctors here do informed consent.  Garramone, the top surgeon I want to work with, will take a letter from your MD, so that is handled once I am ready for surgery.

it could have all been accomplished within 3-4 weeks, in reality - with funding saved, etc.

Holy damn sweet monkeys on a stick :O

3-4 weeks? O.o Honestly? How do they ensure your gender 'problem' is not just a fluke then and you'll regret it all one year later?

That's what the very elaborate process in Holland is for. Just to make sure that no one is making any rushed decisions and you have the needed back up to make it all the way through. We also get most, if not all (even surgery) paid by our health care system, so that's a pro.

The difference is really baffling....More plixplox!

Quote from: Mr.X on March 04, 2013, 04:21:48 PM
3-4 weeks? O.o Honestly? How do they ensure your gender 'problem' is not just a fluke then and you'll regret it all one year later?

Yup, honestly.

They trust you to make the right decisions for your own body.  They educate you on the risks, do tests to make sure you are physically healthy - then, and this is the key - they make you sign paperwork agreeing you know what will happen.

the transitions things is pretty complicated here.
Denmark, Norway and Sweden go under the SK-system. which kind of seam abit simmular to what you decribes in neatherland. Denmark and Norway is almost the same exept few details, and Sweden is abit more diffrent as far I see it.
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In Denmark theres 1 clinnic called "sexologic-clinnic (SK)" who threats transexual and you generally needs permission for them.

to get permission you must go have conversations with them for at least 1 year, to gain homones and at least 2 years for surgery, theres no time limits on how long your to go there, and they can rejejct you or demand your to be in the system for a longer period if they feel like.

your to be asked alot of question for your sexualety, your famely, and all kind of stuff,
its manly said to be very based on sexualety and gender norms, and if you fit them your change to get permission is higher than if your arnt so steryotypical.
its important to remember that this obsevation period you have to go thought arnt to suport you, there to jugde and test you whatever or not they belive your "a true transexual" or whatever or not you should be giving permisision to what you want.
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for those who get permissions it will be covered by insurance but not the traveling part, so if your living far away it can still get rather expensive driving back and forth each month. you need to be sterilizated/castrated to get your gender ID changed and this part is one of the most difficult parts, I only know 3 transpeople who have maneged to change this one have been in the system for 18 years, so its not easy.
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theres also alot of people who dont get the permission, or who simple refuse to go thought the system because there agenst it, dont think they can handle the pressure, or dont belive there to get permission anyway.

they go beyond the system, where find privat doctors for homones or surgery in or outside the country.
manly the doctors are a secret busniss cause the SK-system dosent suport anyone dealing with transgender people beside themself so your are to meet other transfolks to talk to if you want to get the adress of those.
to go beyind the system can easly be pretty expensive, specially if this means going outside the country for threatment. the most normal countrys to seach threatment for homones or surgery, is Sweden, Germany, Belgium, UK and (obviously) Thailand.
some people also do a mix of going in the SK- and beyond the system but it can be risky as SK dosent suport people going beyond the system.
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even when this is the simple version theres political changes in the scandinavian countrys which means that things are changing right now. ex for 1 year back it was imposible to get homone blockers on SK now its posible for people between 15-18 to get permission for that. also they have taking away sterilization in sweden by this january, and norway and denmark seams very likely to bann the rule as well before 2014 which sure will change alot for the better. so its very hard to guide people  100% on the rules, but this is the basic version of it so far.
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I'm only at the beginning of going through the medical system but here in Australia there seems to be a bit of variation from state to state.
So far I have seen my GP, had referrals for a psychologist to go through things with and a psychiatrist who I will need to see for a minimum of three months (with a second opinion) before they can approve me (if they think i suit) for hormones. After that I will likely see an endocrinologist for hormones as they have the speciality to deal with such things (imo) but I understand that once you have psychiatric approval your GP can prescribe (doesn't have to be an endo).
Also, check ups and blood tests are regularly done once starting hormones. That's as far as I know, maybe someone who knows more about the process in SA can elaborate.
I can't help but think how some health systems are so different. On one hand having a straight, laid out path to follow is good as it gives direction etc. but also makes you wait, consider and gives time to work things out Which can be both good and bad.
On the other hand having a 'free-er" system means that if you have the means and know that you definitely want to go so far (HRT, GRS/SRS) then you can.
I know myself well enough that I will likely need FTE to "figure it out" so not a bad thing for me to be where I am. I'm still a bit impatient though! I won't lie, I do want to get things moving sooner than later.

Quote from: spacerace on March 04, 2013, 04:14:50 PM
I am glad you made this thread - the process for transitioning in different countries is interesting to me.

In the pacific NW United States -  no waiting, mental health checks, or steps to take- but we pay for everything in most cases.  Therapy is not required for hormones - several doctors here do informed consent.  Garramone, the top surgeon I want to work with, will take a letter from your MD, so that is handled once I am ready for surgery.

it could have all been accomplished within 3-4 weeks, in reality - with funding saved, etc.

Same here in California. The surgery is the easiest part, since you can get any plastic surgery procedure you can dream of that won't kill you xD. Only real issue is financial. Everything is more expensive to get it done. Only reason I haven't gone full force into medical transition is because all my money is going to school right now :'P.

Thanks for the replies, guys! Seems there are quite a few differences across the world.

Natkat, I know a FtM in Norway, and he can't go anywhere because he's married to a man. This would make him gay, and according to the Norway system, you can't be transsexual then, so they will not help you. Have you ever noticed any of this? Seems like a very outdated system because your own gender identity and your sexuality are two separate things.

It seems that most differences are related to money. If you have to pay for it yourself, the process can be fast. If not, there's long bouts of waiting in between steps. Seeing that there was no way I could have paid for this myself, I'm glad we have the system as it is.

Since you've mentioned the UK system, my experience of it is as follows:

• See your GP to discuss your gender issues. It can take up to a month to get an appointment with your GP, particularly if you want one of the better ones. They'll ask a few questions, then refer you to a community mental health team.
• Community Mental Health Team assesses you. It took me about a month to go from my GP to the community team. This sounds like the beginning of your clinic experience in Nederland. They check you don't have any other mental health issues that could cause gender confusion (e.g. some cases of schizophrenia). If they think you may have GD, they refer you to a Gender Identity Clinic, of which there are several in the country.
• Here's where it all went pearshaped for me. I was referred to London but they have a ridiculously long waiting list because we had some trans documentaries on TV last year, so a lot more trans people have been seeking help. I waited 7 months for them to come back to me without even getting an appointment, before looking into alternatives.
• I've now been referred to a different clinic, and I hope to see them within the next two months. They start with more psychological/psychiatric assessment to make sure I'm not nuts... but then the pathway is less rigid than the Dutch system. They tailor the rest of the process according to the individual patient's needs. Some people go on hormones within a few short months, others have to wait several years. Depends on the individual patient.
• Waiting times for surgeries can be long, and they differ for MtFs and FtMs. For example, FtMs are generally expected to have been on T for at least 2 years before any bottom surgery.

Quote from: Mr.X on March 05, 2013, 04:33:49 AM
I know a FtM in Norway, and he can't go anywhere because he's married to a man. This would make him gay, and according to the Norway system, you can't be transsexual then, so they will not help you.

Some of the Scandinavian countries seem to be downright cruel in their treatment of trans people. I'm married to a man too, and British law currently states that we can remain married until I apply for a Gender Recognition Certificate, but we would have to divorce before I can get that because same-sex marriage is currently illegal in the UK.

Quote from: Mr.X on March 05, 2013, 04:33:49 AM
It seems that most differences are related to money. If you have to pay for it yourself, the process can be fast. If not, there's long bouts of waiting in between steps. Seeing that there was no way I could have paid for this myself, I'm glad we have the system as it is.

The thing is... we are paying for this ourselves. I pay more in National Insurance, and a heck of a lot more in other taxes, than I would have to pay for top-notch private healthcare. So I'm paying more than I should and I'm being made to accept sub-standard service. If I didn't have to pay those ridiculously high taxes I could easily have afforded my own transition and I could've done it on my own terms.

Quote from: Mr.X on March 05, 2013, 04:33:49 AM
Natkat, I know a FtM in Norway, and he can't go anywhere because he's married to a man. This would make him gay, and according to the Norway system, you can't be transsexual then, so they will not help you. Have you ever noticed any of this? Seems like a very outdated system because your own gender identity and your sexuality are two separate things.

many people have been refused for all kinds ridiculous things.
I been refused in Denmark due to my age (16 back then) and my current school + a asperger dignose, and beside those things she have dignosed me with a sexual disorder* who refern that im confussed about my sexualety or gender which im very angry about since im not confussed im just trans )=(.
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I showed up at the clinic for 4  years ago which my doctor sent me too.
they straightforward told my parrents in phone that I would never get permission when I had the dignose I had.
When I showed up at the clinnic for the 2 meetings i got asked alot of questions: what gender my friends are?, what I played with as a kid?, how my famely is? marrige? divorced?, what my sexual oriantation is?, how often I mastrubate? all this kind of things who is a standard scedual you need to fill. she also asked me what my dignose ment, and I was rather disapointed I had to explain it to her when she already had rejejcted me for it .
then later as we talked sex she asked if I had sex with my boyfriend, and I said we hadnt done it yet, and she said I "should do that first." its a I ask, you answer, system as far I remember it.

the typical tips to transfolks is to try to be hetrosexual and as typical as posible if you want to have a high chance to get permission, and lot of people in both countrys feel the need to lie, or hide fact of themself.
yet some of the new transpeople in denmark say that something have changed and your not to be refused by ex being homosexual anymore, I dont know about that because it was 4 years since I was in the system so I dont know how it is now, I can only base my knowlegde on what other tells me and what I experience myself, im going to a political meeting about it in 2 months so maybe there I will know for sure.
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about your friend, I am sure I dont know him, but if he got problems finding homones or anything maybe I can help.
I have some few contacts of doctors in norway or other transfolks who could help depending on the area.

Quote from: Natkat on March 05, 2013, 11:29:01 AM
i got asked alot of questions: what gender my friends are?, what I played with as a kid?, how my famely is? marrige? divorced?, what my sexual oriantation is?, how often I mastrubate? all this kind of things who is a standard scedual you need to fill. she also asked me what my dignose ment, and I was rather disapointed I had to explain it to her when she already had rejejcted me for it .
then later as we talked sex she asked if I had sex with my boyfriend, and I said we hadnt done it yet, and she said I "should do that first." its a I ask, you answer, system as far I remember it.

Denmark is such a lovely country in so many ways... but ye gods, this is brutal.

Quote from: FTMDiaries on March 05, 2013, 11:34:38 AM
Denmark is such a lovely country in so many ways... but ye gods, this is brutal.

yes but ill promist if you where to visit I would make sure your not to get into any fuss
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btw.. I really hope alot of people from diffrent countrys answer in this thread.
I often feel alot of the general knowlegde for how things are for transgenders are manly forced around the states, which sure is fine if you live there or want to visit it, but if you wanna go to other countrys it can be so hard to get good information. I want to be able to travel more in my future, so then its pretty important to know your details of the trans issues, if you ex are to visit isreal, or bali.

Quoteabout your friend, I am sure I dont know him, but if he got problems finding homones or anything maybe I can help.
I have some few contacts of doctors in norway or other transfolks who could help depending on the area.

It would be great if you two could get into contact. My friend is really depressed about the whole ordeal, and I worry for him. Any help would be more than welcome. I'm not allowed to send private messages yet, so any suggestions on how we can exhange emails or the likes without putting them blatantly on the internet would be great.

Quotebtw.. I really hope alot of people from diffrent countrys answer in this thread.

I completely agree. It is likely I'll have to travel a lot for my job in the future, so any information is more than welcome. And to those who already answered, thanks!

We don't really have a "formal" process in Brazil.

Some of us go through the public system, but that's mostly directed to MTF transitions and you have to go there for a couple years before they'll confirm your diagnosis and authorize you to have any sort of surgery. The process itself is free, but there's a waiting period with the appointments and getting a surgery date. I'm not entirely sure how they go about hormones, but I'm fairly sure they will give you a prescription within a shorter time frame.

You can also go through the private system. You have to pay for everything yourself, but it can be easier, and faster, provided you can find doctors who are willing to treat transgender patients and that can be difficult. When you do find them, it can also be a long time before you can get an appointment. I actually called a doctor last week who only had openings for November.

I'm going through the private system, currently looking for an endo who will take my insurance.

Quote from: Mr.X on March 05, 2013, 11:59:37 AM
It would be great if you two could get into contact. My friend is really depressed about the whole ordeal, and I worry for him. Any help would be more than welcome. I'm not allowed to send private messages yet, so any suggestions on how we can exhange emails or the likes without putting them blatantly on the internet would be great.

depending on his situation, where he live or how many money he got it could get difficult but I could give it a try.
I dont know if your able to recive messages, in that caise I can send you my email and you can just contact me there.
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Lucas:
do you have an idea, more or less how long this waiting period is in Brazil?

In Hungary you need to see two therapists, they will decide if you're really trans or not. I waited 2 months for one of my appointments, and maybe 4 days for the other? It's really depending on the doctor. It took me about 5-6 therapy sessions to get the letters that says I'm trans therefor I can change my name and gender, get hormones and surgeries. It's up to you when you get it done.
I had a conversation with my ex girlfriend about how much easier is this whole transition thing by us than in some places for example in north Europe. And really, if you are in a rush you can do it within 2 months, I mean the therapy, name change and getting on hormones. I did it slower because of my school.

What is it like in CT USA ?? Do i need to get a letter first ? In order for me to start T ?? Does anyone know of a doctor that doesn't require a letter in CT ?  I have been going to my Psychologist at my University for over a year and dont want to have to go somewhere else and pay money just to have someone say i can do it. 

Quote from: spacerace on March 04, 2013, 04:14:50 PM
I am glad you made this thread - the process for transitioning in different countries is interesting to me.

In the pacific NW United States -  no waiting, mental health checks, or steps to take- but we pay for everything in most cases.  Therapy is not required for hormones - several doctors here do informed consent.  Garramone, the top surgeon I want to work with, will take a letter from your MD, so that is handled once I am ready for surgery.

it could have all been accomplished within 3-4 weeks, in reality - with funding saved, etc.

I find this to be a bit misleading. The time varies from state to state, especially considering that you need letters for much of the process (gender markers, referrals, etc.). I think a more reasonable time-frame is 6 months. Therapists' (and other care providers') understanding of Trans-issues is an important factor; not everyone has access to practices that specifically recognize the trans community. Also, there are often wait times for scheduling -- especially so if you want to find care in a trans-respecting environment.

I personally think that systems that require some amount of time before being able to move on to hormones or surgical transitions are beneficial -- each step is a huge decision to make, and it's better to think it through extensively than to make rash decisions.

Quote from: utouto on March 05, 2013, 04:42:04 PM
I find this to be a bit misleading. The time varies from state to state, especially considering that you need letters for much of the process (gender markers, referrals, etc.). I think a more reasonable time-frame is 6 months. Therapists' (and other care providers') understanding of Trans-issues is an important factor; not everyone has access to practices that specifically recognize the trans community. Also, there are often wait times for scheduling -- especially so if you want to find care in a trans-respecting environment.

I personally think that systems that require some amount of time before being able to move on to hormones or surgical transitions are beneficial -- each step is a huge decision to make, and it's better to think it through extensively than to make rash decisions.

It varies not only from state to state but also from doctor to doctor.  Some will do informed consent, some want a letter (which leads to the inconsistencies in therapy: some therapists want a solid length of time for you to be in therapy before they are willing to give you a letter, some will give you a letter on the first visit.).

Yes, I am sure it varies from state to state - that is why I specified that I live in the Pacific NW. Maybe people who live in others states should describe their experiences?   

Quote from: utouto on March 05, 2013, 04:42:04 PM
Also, there are often wait times for scheduling -- especially so if you want to find care in a trans-respecting environment.

I personally think that systems that require some amount of time before being able to move on to hormones or surgical transitions are beneficial -- each step is a huge decision to make, and it's better to think it through extensively than to make rash decisions.

I think the opposite is actually true - doctors that let trans people make their own decisions is a much more respectable environment than someone who demands a permission slip to confirm your identity. Doctors that are willing to do informed consent have a process setup to handle it. They work with other trans patients, and they don't need to be walked through things or have it explained to them.

I don't want to get into a debate about informed consent, but I think steps are good if you want them and need them - but why should that be up to someone else to decide?  I personally think people should control how decisions about their bodies are made. Enforced steps create a paternalistic structure around the trans population.