I keep reading and seeing comments about informed consent access to HRT, I thought it may be helpful to see it from the professional view.

Quote:
There appears to be some confusion around the notion of "informed consent". Within the medical community informed consent is considered a core principle of practice and it is considered standard practice to obtain informed consent prior to any medical intervention. To obtain informed consent the physician must be satisfied that the patient has been given comprehensive information about the proposed treatment. This would include information about the expected effects of the treatment, the possible risks or complications and any alternatives to the proposed treatment. In addition the physician must be satisfied that the patient has the capacity to consent to treatment. In other words, the physician must conduct an assessment of whether the patient has the cognitive ability to make a decision and is free from coercion. This can be a very complex assessment and needs to address the patient's ability to understand information about treatment; their ability to appreciate how that information applies to their situation; their ability to reason with that information; and their ability to make a choice and express it. In all situations therefore it is important that a physician conducts a comprehensive assessment to ensure that the treatment being prescribed is safe and appropriate. Informed consent therefore is not "treatment on demand".

A number of clinics in the US and Canada have developed protocols in relation to accessing hormones based on an informed consent model. Examples of these clinics include: Tom Waddell Health Centre (San Francisco), Catherine White Holman Wellness Centre (Vancouver), Fenway Community Health Transgender Health Program (Boston) and Howard Brown Health Centre (Chicago). A core feature of all these protocols is that a comprehensive assessment is made prior to prescription of hormones to assess the appropriateness and safety of prescribing hormones for any individual requesting hormones. In some of these protocols (eg Fenway) the assessment must be conducted by a mental health professional. WPATH has reviewed these protocols and states "The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment."

Wait, are you asking what informed consent is..?

No. What it is.

Cindy, I wonder if a better term for what we've been referring to as "informed consent" would be "informed consent only."

I.e. all surgeons use informed consent for all procedures, but gender reaffirming procedures tend also to have other requirements. (GID diagnosis from a doctor who will often ask us to jump through hoops to prove it to him, etc.)

This is why I posted this. This is informed consent from gender therapists in Australia according to WPATH.

Suzi, there is no requirement for GID, the hoops you jump through are local hoops, not hoops that the professionals use.

That is a major issue with community - professional relationship.

The hoops are not from the true professionals.

I'm trying to deal with that.

Pikachu; hormone on demand means some people will die. I and others in the profession reject that idea as a health concept

Quote from: Cindy on May 09, 2014, 11:10:08 AM
Suzi, there is no requirement for GID, the hoops you jump through are local hoops, not hoops that the professionals use.

I'm on page 104 of the SOC v7, under the section labeled "Criteria for Feminizing/Masculinizing Hormone Therapy". Item #1 says "Persistent, well-documented gender dysphoria".

I have to read that as saying that the WPATH wants a diagnosis of gender identity dysphoria before hormones are prescribed. (Is there some other way to read it?)

Because there is no one presentation for our condition - each of us seems to experience it totally differently - diagnosis criteria is highly open to individual interpretation, and each local practitioner will have their own test, right?

I live in the USA in Pennsylvania.

I did an intake, whent to therapy (3 months), received a GID diagnosis from a licensed social worker, got scripts for hormones and never signed an "informed consent" form.

The PA I go to asked me questions if I knew what the health risks were and the effects of the hormones. He also asked me several questions to access my gid severity and length of time I had it. He is very cute, has beautiful eyes and a seducing voice, almost mesmerizing. He looked into my eyes up close the whole time of the interview. I believe he was looking for eye dilation or some other visual indicator of truth. He just made me hot and love struck He is so sexy and exactly my type!

I thought informed consent was.

Making sure the patient was awear of all the INFORMATION before CONSENT was validated. or needing a refferal from a person in an informed position such as a gender therapist.

I think informed consent is wonderful.  The deaths averted through preventing trans suicides by allowing people to get medication they desperately need far outway the potential risks of taking the medication which are pretty much exactly the same risks as people who get "letters" from pyschologists.  Getting a letter doesn't make hrt more or less dangerous.  Worse case scenario you start growing some boobs and don't like them and quit.  These places are also very nice and don't pressure people into transitioning unlike many therapists and personal endos.  "WHY AREN't YOU WEARING A DRESS and make up!  I thought you were a woman!".  Ya no.

All you are doing by restricting access to informed consent clinics is forcing kids to self med which is what is actually dangerous (though much less dangerous than letting T have its way with your body), not receiving hormone medication from a liscensed professional with a "letter" (as though the letter automatically makes everything safer lol).

I want to expand on the discussion of informed consent and point out that when I give informed consent for a procedure, the information and the paperwork is usually brief and hurried, and I am often asked to sign things without actually seeing paperwork.

I give informed consent frequently, at least once a week, for either myself or my kid. When I do ask questions I feel like I am being read a script in response, if there is a response. Sometimes the answer is something along the lines of "are you going to sign or not?"

If I were confronted with the decision to give consent that actually required thinking or research and hadn't done it ahead of time, I would be out of luck and I would anger those I go to for healthcare.

Either paperwork has gotten out of control and meaningless in my country, or healthcare providers in my city are all burnouts. I'm sure it might be a mix of the two, but "informed consent" for transgender care doesn't seem to be available where I live and "informed consent" for everything else isn't really informed and is only barely consent.

There definitely are places which practice informed consent (or should I say informed consent only) without therapy. There is a place here where basically you are given a list of the side effects and many possible effects of hormones and then are asked to sign it. You have to have labs. No therapist or counselor of any kind and no intake. I had what was likely to be considered to be informed consent for T. My PA asked me numerous questions. I imagine she could have refused, she kind of wanted to know what my support system looked like, what my general health was, and so on. That was pretty much it, there was no long involved system and I didn't sign any forms (though I think this is typical of a formal "informed consent" system). I had labs. And basically got my T within 2 weeks after I saw her (and one physical appointment). I've heard the clinic above is faster.

The Transgender Resource Center here in Albuquerque (awesome place) did a training on informed consent following the standards set by the Center for Excellence for Transgender Health here: http://transhealth.ucsf.edu/trans?page=protocol-hormone-ready
None of this involves having mental health personnel assess the patient, but most likely involves history taking.

Quite a lot of people will take hormones illegally including the use and exchange of needles so there is great benefit to getting people into the legal system with medical supervision.

Some of the centers you mention would likely do some kind of intake, but that's because they are clinics and clinics in the US typically use intake procedures done by social workers. This doesn't necessarily mean these are in depth procedures to access diagnosis. Some of these may be informed consent in name only. If lengthy psychological or team evaluations are involved, I don't know what the point of informed consent is.

FTM top surgery is sometimes performed via informed consent. I think it is nearly unheard of (in the US) for bottom surgery.

I have no idea how it is practiced in Australia, but the idea that informed consent always (or even mostly) everywhere includes therapy isn't really true.



--Jay

Quote from: Felix on May 13, 2014, 01:09:11 AM
I want to expand on the discussion of informed consent and point out that when I give informed consent for a procedure, the information and the paperwork is usually brief and hurried, and I am often asked to sign things without actually seeing paperwork.

I give informed consent frequently, at least once a week, for either myself or my kid. When I do ask questions I feel like I am being read a script in response, if there is a response. Sometimes the answer is something along the lines of "are you going to sign or not?"

If I were confronted with the decision to give consent that actually required thinking or research and hadn't done it ahead of time, I would be out of luck and I would anger those I go to for healthcare.

Either paperwork has gotten out of control and meaningless in my country, or healthcare providers in my city are all burnouts. I'm sure it might be a mix of the two, but "informed consent" for transgender care doesn't seem to be available where I live and "informed consent" for everything else isn't really informed and is only barely consent.

What exactly is the difference between informed consent and how one normally gets perscribed hrt medication?  Most therapists are not doctors who can explain hrt medication.

@Felix, I think in cases where there is just an intake type person (like a social worker), they don't actually know that much. They hand you a form to read, and go thru it with you.

If there is actually a therapist determining if you can take hormones or not, I don't know the difference between informed consent and what's normally done now.

That's not what's going on here with informed consent. It literally is a form that you sign and the doctor (or some other PCP) goes over the side effects and so on and expectations. Informed consent, means you can say you are okay about it, but only if you know what you are saying okay to. I don't see how it is okay to call informed consent where some therapist examines you, but I do believe all informed consent programs require labs and medical hx.

--Jay

Cindy,  there is one more aspect for informed consent that is important in Australia - that is alternate treatments have been offered and that the possible advantages and disadvantages have been explained.  Medico-legally, this aspect cannot be disregarded and there have bee sufficient precedent in court establishing this.

Other than that, your quote is spot on.

Another interesting little tidbit is that a medico in Australia is obliged to inform a patient about every possible outcome, no matter how unlikely, should the patient demand that information, even if the likelihood of an event happening is one in a million.

I feel the idea of a therapist determining if you should have T is called informed consent, they are completely undermining the whole point of informed consent which is to give you agency in transgender treatment. I'm sure the people who thought of the idea of informed consent would be *really* upset with it.

--Jay

so wait, as long as you have informed constant, you basically bypassed the 3 month therapy requirement?  i mean like i got it really bad and i know i wont survive long enough to comeplete 3 months especially now i have to find another therapist who is outside where i live and my insurance difinitely wont cover any therpay outside my state o.o though i dont mind the therapy, it gives me hope i can do therapy but also start my meds o.o

Here is a link to Howard Brown Clinic in Chicago who uses an informed consent model for trans care.

http://www.howardbrown.org/hb_services.asp?id=37

I go through them and the basic difference is that as long as you are of sound mind and understand the benefits and side effects of starting HRT and your lab work is clean then you can proceed to start HRT with them.  Vs the S.O.C which require a diagnosis of some kind to be made and then the appropriate a treatment plan to be set in place.

Quote from: Penny Gurl on May 14, 2014, 06:43:45 PM
Here is a link to Howard Brown Clinic in Chicago who uses an informed consent model for trans care.

http://www.howardbrown.org/hb_services.asp?id=37

I go through them and the basic difference is that as long as you are of sound mind and understand the benefits and side effects of starting HRT and your lab work is clean then you can proceed to start HRT with them.  Vs the S.O.C which require a diagnosis of some kind to be made and then the appropriate a treatment plan to be set in place.

so if i prove that my dysphoria is causing my mental instability and current mental diagnoses, have my blood work clean and sign the informed constant, i can proceed with HRT?  if thats true than i'm gamed becuz once again, i difinitely cant survive the 3 month process without have]ing near death dysphoric attacks

you would meet with an HRT advocate who explains the process and also takes time to discuss your personal transition plan.  Basically they want to make sure that this is a well though out decision, generally you'll go in for a medical appointment first to get your blood draws done then when the labs are back and you have met with the advocate if everything checks out you meet with a medical professional and discuss your treatment options.  It's not necessarily about proving or disproving anything it's more about knowing what your body will go though.  Granted Howard Brown does some some info on there program that you can download and read over.  And if you need any other questions answered you are able to call them and they can give you a clearer understanding of their process.

Quote from: Penny Gurl on May 14, 2014, 06:54:06 PM
you would meet with an HRT advocate who explains the process and also takes time to discuss your personal transition plan.  Basically they want to make sure that this is a well though out decision, generally you'll go in for a medical appointment first to get your blood draws done then when the labs are back and you have met with the advocate if everything checks out you meet with a medical professional and discuss your treatment options.  It's not necessarily about proving or disproving anything it's more about knowing what your body will go though.  Granted Howard Brown does some some info on there program that you can download and read over.  And if you need any other questions answered you are able to call them and they can give you a clearer understanding of their process.

my only concern is if the advocates are in my area. i can proved my most result blood panel but are there advocates in the NJ area