If you've been reading my thread on the SRS board, you'll know I recently had a surprising experience with a middle-aged male psychologist who I'd gone to see so he would write a referral letter to my surgeon.

To summarize, he began evaluating me and we seemed to be having a decent session when he suddenly went all gatekeeper on me and told me I wasn't ready for a letter.

This is the second time I dealt with a middle-aged male who was doing a psych eval and somehow moved him to conclude he needed to put the breaks on some aspect of my transition.

My own therapist, who knows both those individuals well, said that the behavior surprised her, because that was not characteristic of either. And she did verify that by no one's criteria is there anything in my case that should indicate delaying my transition.

I'm led to speculate why I bring out seeming uncharacteristic gatekeeping behavior.

I wonder if males who came of age in the days where strong professional women were not as much in evidence are somehow triggered by women who appear accommodating and feminine but who have a professional level of confidence in their own knowledge and judgment. There was a period even in my own lifetime, where the belief was still widespread that women's judgment was inferior to men's.

I'm very well read, very intelligent, and on top of that have a cocksure attitude that convinces me I know a whole lot more than I actually do.  However, I have a verhy female presentation, a feminine voice that is not strong or forceful, and body language that is sometimes kind of meek and demure.

But personality-wise I'm not like that. I have strong opinions and I refuse to allow myself to be stared down or cowed. I'm quick to challenge someone who says something I disagree with, and have no qualms about pointing out flaws in other people's logic.

I wonder if that combination triggers something in men of that age, some need to put me in my place, some need reestablish their gravitas.

Has anyone else had experiences like this?

I never went to a therapist. I didn't need to pay someone to agree with me on a topic I was already aware of.

Can't say I've had that experience. All of my the*apists were quite understanding and agreeable, no gatekeeping of any sort.

On the other hand, maybe they matured in the era when doctors (or other authority figures) were Kings of the Roost, and one simply did NOT question their Ah-tori-TAY!!

Maybe it was a kind of "alpha male" response?

do you need to go to a middle aged male for justification?

Transphobia is incredibly common in medicine, and most psychiatrists have zero training in trans care.
That is why I intend to see a Dr who is a member of WPATH for my second surgery letter.
Those doctors both failed to follow the Standard of Care. Your temperament and presentation are completely irrelevant. The determination they were paid to make is this:
Does the client have gender dysphoria that will be reduced by surgery, and does the client have a successful year living in her gender. Period. And for non-genital surgery no determination is needed.

Suzi, I think you'll find that while women don't generally like overly assertive males they like it even less coming from other women (you can't win). I'm guessing that "cock sure" approach you mentioned probably wouldn't win you many brownie points from any female doctor/counsellor.

Quote from: Ms Grace on November 12, 2013, 12:38:40 PM
Suzi, I think you'll find that while women don't generally like overly assertive males they like it even less coming from other women (you can't win). I'm guessing that "cock sure" approach you mentioned probably wouldn't win you many brownie points from any female doctor/counsellor.

But if they are professional, Suzi wouldn't even know how they felt.

I am a medical student and not a doctor, so I'm absolutely not taking sides, or criticising anyone here, but let me try to give you a view of the potential problem, from the other side

Having looked at the thread in question I absolutely do agree that moving the goal posts, or at very least failing to specify where they were in advance, seems very unfair. In my opinion you certainly should have been made aware of where he was going to set the bar BEFORE you got there.

As regards his refusal however, sadly there have been numerous cases where doctors who sign letters too far in advance have then been subjected to professional misconduct and/or legal proceedings later when someone appears to have had subsequent regrets. So from a professional point of view it's very difficult because unfortunately the courts are less trans friendly than doctors and do tend to want to believe that all trans people are nutters – and that therefore that anyone who "says" that they weren't properly assessed "must be telling the truth", because the lawyers all seem to believe that no one in their right mind would ever genuinely WANT such a procedure.

The ONLY defence that works against this line of legal reasoning is that the doctor involved followed the agreed treatment guidelines TO THE LETTER! This places any medical professional in a very awkward position, because much as they might like to believe the strong intelligent professional person in front of them, sadly experience also shows that these are quite often the ones most likely to sue if something later changes...

I speak from somewhat personal experience, because my best friend, a doctor of some considerable experience, was sued by a trans patient under just those circumstances, because she claimed that in failing to enforce the 1 year rule TO THE LETTER he had failed in his duty of care, because had he done so she would have changed her mind... there is in fact no way to prove or disprove this. It becomes his word against hers. This despite the fact that at the time she was probably calling him all the bastards under the sun for suggesting that she should maybe wait.

So the doctor is often placed in a no win situation. You bend the rules for one, and sod's law means it's the one you should have stood up to. You don't bend for someone else and they will almost inevitably turn out to be the one that really needed it! The problem is if we don't have any guidelines, then it becomes open season on the medics, who then have no solid defence, other than "well in my judgement..." which a skilled lawyer can and often will rip to pieces.

So what I do think was very unfortunate is that you were unaware of what his attitude was going to be, because that denied you the chance to save your fee and go elsewhere, which of course has to be your right!

I haven't had a lot of experience, but my therapist did warn me about how I talk about HRT to the endo... don't consider it a "trial," for one. I only mentioned to him that I was aiming for HRT and that I think I'd know then if it fixed a problem or not. I do have a bit of a different outlook on it now, though (god I need it - that sums it up). I meant what I said, though... I never expected I wouldn't be on it for life, but those first 3 months of E would probably tell me I made the right decision.

I wonder if it could be the same way with the PhD Psychologist's letter... if you were talking about how far off it was and just wanting your ducks in a row... he might have gotten scared off, thinking you were still working on thinking it all through. . . really you just meant what you said - that you want everything ready to go so you don't have to worry about details.

I think it's just a one year RLE thing. If there is at least 1 year and the person still wants surgery then they should get a letter. Less than a year by therapist shopping is risky not for the trans person but for a medical professional since their own credentials are on the line. I know after a year I wanted surgery and after 2 years I sill wanted it (still doing genital electro at the time) and when I finally showed up the letters were a few years old but nobody cared.

I myself lived out the full year and then asked for letters and had no problems,
No gatekeeping nothing.

Quote from: Beth Andrea on November 12, 2013, 12:41:17 PM
But if they are professional, Suzi wouldn't even know how they felt.

True, but there's "professional" and then there's "human nature"...

If I need to go to the doctor I go to the doctor. Never had a problem.............

I have to wonder where a trans person sees the medical field being negative towards them. Now ignorant sure since we are such a small population. Providing poor service? Do explain that one?

When I had my general assessment by a regular psychiatrist Aka Dr.Wolf, he was quite sexist. I was told to just be myself.
So I went to the consultation wearing a sporty V neck t-shirt and green Combat pants some of his questions did ask. "Why aren't you wearing a Skirt?" "why aren't you wearing make-up?" I was snarky and sarcastic like I am when people ask me really stupid/inappropriate questions. He didn't really compute what I was telling him. He also used the infamous HBS scale and I made another off the cuff remark about that. I equally responded with humor and sass when he asked me about "how do you masturbate?"

In his report while he was generally positive about his report about me he made remarks about these events and how he didn't see these behaviours as traditionally feminine.
Subsequently whenever I've gone to Charing Cross GIC I've always made abit of effort to Gussy up put light make up on and wear a femmy outfit with a skirt before going and I dial back the snark. I don't know if it's due to this or if they don't care about it but I've not had any problems with it since. Just play the game... If they are misogynistic your not going to change them.

This is exactly why I specifically chose to work with a woman. Women are way more compassionate to our struggle. For me my therapist was very understanding and helpful. She started to be a bit of a gatekeeper towards the end of our sessions, but once I explained myself in a very firm precise way she totally changed her mind.

Also I think it's VERY important that we watch what we say and stick to clear unwavering answers. They get spooked when they feel we aren't being clear or vigilant.

Quote from: pebbles on November 13, 2013, 01:46:08 AM
Subsequently whenever I've gone to Charing Cross GIC I've always made abit of effort to Gussy up put light make up on and wear a femmy outfit with a skirt before going and I dial back the snark. I don't know if it's due to this or if they don't care about it but I've not had any problems with it since. Just play the game... If they are misogynistic your not going to change them.

My regular therapist urges me to do the same whenever visiting my psychologist. I'm told that approval for SRS many years ago used to be more subjective, almost based on how well you pass and fit into the female stereotype. I'm warned that not all of those inclinations are gone. Having said that, I'm not aware of anyone who's had any such issues with my psychologist. But who knows what the second psychologist ( for second SRS letter ) will be like...

I've had numerous encounters with men & one women. It seems to me that most just wanted their hourly fee & most had no real concern other than just continuing appointments to get paid.

Quote from: FrancisAnn on November 13, 2013, 04:00:42 AM
I've had numerous encounters with men & one women. It seems to me that most just wanted their hourly fee & most had no real concern other than just continuing appointments to get paid.

I think my therapist is great... but that hourly fee is a source of contention between me and my wife... her therapist will talk to you for hours and go way out of the way after hours for that one session fee. I see her as a pretty special case among therapists - though I don't have a ton of experience. We also deal with uncommon specialists, not family or child therapists. My therapist does not extend appointments and wants to be paid for any major outside time he puts in. I have to assume that's pretty normal?

Yeah I think a lot of doctors want to "help" us when we are desperate and pathetic. If they just see us as men then they probably won't be happy that we are confident and strong willed women.

Seems absurd that medical professionals could be this way, but totally true.

I've had the fortune of only dealing with progressive gender clinic, never had to see a therapist for HRT.

I won't be able to have SRS for a while because I don't have the money yet but I saw a therapist at the LGBT center here in NYC this summer to get a letter ready. He was awesome and understood completely that I was getting this letter lol

Doctors are funny. They think their denial of our reality means something. Sucks when we spend our money on them and totally abhorrent that they can erect blockades to our transition and this wellness.

Also, I am really troubled by trans people who seek out transition and then blame clinics or doctors for their mistakes. I guess it bothers me because those of us who need this /know/ we need it and it's upsetting that others would complicate that.

I also knew I needed HRT but obviously had no reference point or expereince with it. So when I started I viewed it as a diagnostic step. If I was trans really then HRT would make me feel better. That's not irresponsible or troubling it's normal and true.

Anyway sorry you're getting this drama.

Quote from: PrincessDi on November 13, 2013, 04:41:12 AM
Also, I am really troubled by trans people who seek out transition and then blame clinics or doctors for their mistakes. I guess it bothers me because those of us who need this /know/ we need it and it's upsetting that others would complicate that.

I also knew I needed HRT but obviously had no reference point or expereince with it. So when I started I viewed it as a diagnostic step. If I was trans really then HRT would make me feel better. That's not irresponsible or troubling it's normal and true.

EXACTLY - but now put those two statements together and you see WHY doctors are sometimes a bit weird. In fact very few of the current generation would see you as a man because we've been taught differently than previous generations of students, because the pathophysiology of condition is now a lot better understood.

The problem in a nutshell is that we have no magic power to look inside your head and thus distinguish the genuinely sure, from those who are actually putting on an act to try conceal their doubts, and who may later become troublemakers and cost us our medical licences. This has happened - and not just once. So a doctor  who bends the guidelines in the sincere desire to help someone, then potentially finds him or herself without a career... which makes us nervous.

That tension that you feel is the human cost of the lack of a rigorous method of diagnosis, which currently relies mainly on belief and trust in what someone says... Someone who can then change their mind, go to a court and effectively end that clinicians career.

Yes that makes sense