Currently the WPATH guidelines and nearly all well-regarded surgeons require a year of living as the sex you will be reassigned to before getting SRS, regardless of the the situation. This has come to be called RLE or real life experience. This has been discussed in a recent thread and a column on susans.org..

What do you think? Should surgeons require RLE for all patients or should it be up to the patient whether RLE would be helpful?

My choice in the poll is entirely predictable, - optional only.

Its really a tough call between the two either way. There's just too many issues with both for them to work.

I feel like it should be a decision between yourself, your doctor and any therapist you are seeing at the time.

Its not really something that a lot of people can determine for themselves. You may feel like you don't need to go through it but underlying issues arise afterwards and now you're regretting going through so soon. Others know right away and no amount of RLE changes how you feel.

I myself felt like the latter and while I resented having to go through a whole year before I could get the letters to be approved for surgery, it also helped me grow and have a chance to see how everything is changing before one of the biggest changes in my life will occur (2 1/2 months to go!!!!) I no longer resent going through the 1 year RLE but it does annoy me a bit that it delayed the surgery.

back to my original opinion though, with a consult between your therapist and doctor, they can help determine if you would be one of those that won't really get anything out of the RLE and be able to write up like an exception letter stating that they feel that you are prepared for surgery.

Of course you'll still get the people that talk about liability if whoever is getting the surgery regrets and blames whoever thought they should but that happens all the time anyway.

I lived as a woman full-time for over two years before getting GRS, just because that's how long it took me to save up the money for it. I still don't think that that experience taught me anything about what having different genitalia would be like; I learned a lot about how women are treated in society, but the funny thing is, I was able to get those lessons just fine with a penis. The only thing GRS changed for me was my relationship with my own body (and my wife's relationship with it, to be fair). By that point nobody I interacted with had any idea what my bits looked like anyway, and while there was definitely a learning curve to having and caring for a vulva and vagina, it's not like presenting as female while clothed did anything to give me a head start on that either.

The whole point of transitioning is to help you intergrate into society as you desire to be.
And if your not already active in the comunity there is no garantie you will be after srs.
The funny part about all this is, is that many of us have already been RLE, long before RLE related documentatin is requested. And knowing I presented in public mounths before my legal name change, and my name change document being my first related document, I feel robbed of those months.

The real problemb of RLE is how you are exspected to do it. I mean say your MtF and your a tomboy, the clothes you wear might be preferably male patten, both before and after, so even in this sence you might allready be pressenting as you wish too, but some people may sugest since your MtF, your not presenting as F, so you have no F related RLE.

I understand the nescessity for RLE, but what needs work is what RLE requires. (that is what needs to be changed)
Its the steriotypes even within the trans comunitty itself that need tearing down, for RLE to work for everybody.
And although, at the moment RLE isnt as acomadating as it should be. I still think that it should be required, but it needs to be made to work around everyone, instead of making people work within it.

I think it should be required.  The risk of regret it too great.  Its different thinking about being a woman and actually living as a woman.

IF THE PROBLEM IS SO BAD THAT THERE IS SIGNIFICANT MENTAL ANGUISH, UNDER THE CURRENT GUIDELINES, THE REQUIREMENT CAN BE WAIVED....

In essence, it really is between you, your psych and the performing surgeon.  I know because they waived it for me..

Jen

Quote from: ButterflyVickster on August 14, 2015, 10:37:57 AM
I understand the nescessity for RLE, but what needs work is what RLE requires. (that is what needs to be changed)
Its the steriotypes even within the trans comunitty itself that need tearing down, for RLE to work for everybody.
And although, at the moment RLE isnt as acomadating as it should be. I still think that it should be required, but it needs to be made to work around everyone, instead of making people work within it.

I am skeptical that it can be changed to fix this problem. Stereotypes run deep, and plenty of doctors and therapists still follow guidelines that are decades out of date. Your tomboy example nails the main problem I have with it, and I do not see a way to resolve this. Gender expression varies so widely that I would challenge anyone to come up with a definition for RLE that is fully inclusive. I warrant that this is impossible, so the only non-discriminatory definition of RLE would amount to asking the patient if they've been presenting as they intend to present. Since all it takes is a "yes," this is essentially meaningless and there's no reason to bother with the pretense---just call it a waiting period to ensure the need for surgical transition is adequately persistent.

Quote from: JLT1 on August 14, 2015, 11:26:02 AM
I think it should be required.  The risk of regret it too great.  Its different thinking about being a woman and actually living as a woman.

The thing is, there is no reliable evidence that RLE prevents post-surgical regret any more effectively than randomly denying people access. Given the very low incidence of regret, unless RLE is unbelievably good at weeding out cases where regret is likely, its main effect is going to be denying needed treatment from good candidates.

I say "unbelievably" because, as others in this thread and the earlier one have pointed out, living in a female role and having female genitals are at best tenuously connected. The RLE test does not test at all for the preparedness for the anatomical change. It makes sense as a surgical prerequisite only if the goal is to ensure that surgery is available only to people who fit whatever standards of female or male presentation are needed to count as RLE. That does not strike me as a legitimate goal.

Quote from: jeni on August 14, 2015, 12:28:53 PM
I am skeptical that it can be changed to fix this problem. Stereotypes run deep, and plenty of doctors and therapists still follow guidelines that are decades out of date. Your tomboy example nails the main problem I have with it, and I do not see a way to resolve this. Gender expression varies so widely that I would challenge anyone to come up with a definition for RLE that is fully inclusive. I warrant that this is impossible, so the only non-discriminatory definition of RLE would amount to asking the patient if they've been presenting as they intend to present. Since all it takes is a "yes," this is essentially meaningless and there's no reason to bother with the pretense---just call it a waiting period to ensure the need for surgical transition is adequately persistent.

This statement has merit.  Making a non-gender normative individual who desires SRS be required to conform to a gender normative presentation does not make any sense.  This is why there are exclusions in WAPTH that are quite broad.  If an individual doctor does not follow ALL parts of a guidance and the most recent guidance does not mean the guidance is wrog, it means the doctor does not have the patient's best interest in mind.

Quote from: jeni on August 14, 2015, 12:28:53 PM

The thing is, there is no reliable evidence that RLE prevents post-surgical regret any more effectively than randomly denying people access. Given the very low incidence of regret, unless RLE is unbelievably good at weeding out cases where regret is likely, its main effect is going to be denying needed treatment from good candidates.

The only studies of which I am familiar with are those that show a 95+% success rate in terms of no surgical regret.  I am not familiar with any study which shows comparable data to this.  Something that shows that 95% of individuals who don't have a full year of RLE prior to SRS do not have regret would be great. 

The only credible evidence is that the current situation works 95% of the time for those who complete 1 year RLE.  There is no other qualitative information on dropouts, suicides ect.   

It seems that the bigger problem is that doctors use the one year requirement as an absolute rather than as a guide.... The second problem is a lack of information on the number of people who don't succeed in the 1 year RLE requirement.

How can something get better if we don't quantitatively know what is bad?

The current requirement at least works part of the time.  Allowances were made for unusual or problematic situations... 

How many people have actually read through the standard that seems to be so hated?  Then argued with the doctor?

Jen

Quote from: suzifrommd on August 14, 2015, 08:34:56 AM
Currently the WPATH guidelines and nearly all well-regarded surgeons require a year of living as the sex you will be reassigned to before getting SRS, regardless of the the situation. This has come to be called RLE or real life experience. This has been discussed in a recent thread and a column on susans.org..

What do you think? Should surgeons require RLE for all patients or should it be up to the patient whether RLE would be helpful?

It should be optional; after all, excepting genderfluid or genderqueer people to live as either males or females before they can get SRS is certainly extremely unfair to these people.

My vote is the same as always. I intend to present male after srs so clearly I have a lifetime's RLE behind me already.

The merit in RLE prior to GRS is that it can help one realise they can in fact be their identified gender without needing surgery. I know that's exactly where I am at the moment... coming up to my second year of RLE I don't desperately feel the need for GRS because I am living as a woman and very happy with my life. But I am still actively considering surgery and likely to book soon because of a number of personal reasons. That said, I still feel that RLE should be optional with the caveat that the system needs to have some safety nets in place for those in a mad rush and/or unrealistic expectations.

Quote from: Ms Grace on January 30, 2016, 02:53:46 AM
The merit in RLE prior to GRS is that it can help one realise they can in fact be their identified gender without needing surgery. I know that's exactly where I am at the moment... coming up to my second year of RLE I don't desperately feel the need for GRS because I am living as a woman and very happy with my life. But I am still actively considering surgery and likely to book soon because of a number of personal reasons. That said, I still feel that RLE should be optional with the caveat that the system needs to have some safety nets in place for those in a mad rush and/or unrealistic expectations.

Out of curiosity--exactly what kind of real life experience would gender-fluid and genderqueer people have?

Quote from: AnonyMs on January 30, 2016, 01:31:46 AM
My vote is the same as always. I intend to present male after srs so clearly I have a lifetime's RLE behind me already.

Hang on--to clarify--are you a tomboy?

The guidelines are just that, guidelines not rules set in stone. Most doctors only require a letter from two mental health providers one required to be an MD.  Most providers will only give the letters after one year RLE and most insurance companies also require the 1 year RLE before they will pay for coverage. 

If you are willing to pay cash it is very possible to get your letters and have the surgery without having to go through the 1 yr RLE.  I know at least one member here who was able to get her surgery without having completed 1 year RLE.

As I've said before, requiring RLE before offering treatment is like sending a recruit into battle in order to train as a soldier.

I know there are some arguments for it, for instance it can prove your determination. It can also save the health carers money and I suggest this is the main reason for RLE. There might be a stampede were obstacles not put in the path.

However, it's an arse-about-face way of dealing with this in my opinion. At the very least, hormones should be prescribable prior to RLE as they are part of the enabling towards transition. Surgery in various guises can be optional. It's incredibly hard for some people to live in another gender without offering some of the medical benefits towards it at the start of 'RLE.'

There's also a mahoooosive gender binary agenda that propels this way of thinking, which may be changing slowly.

Quote from: Futurist on January 30, 2016, 02:55:44 AM

Quote from: AnonyMs on January 30, 2016, 01:31:46 AM
My vote is the same as always. I intend to present male after srs so clearly I have a lifetime's RLE behind me already.

Hang on--to clarify--are you a tomboy?

No, but social transition is a big risk for me, so it seems only logical to manage my dysphoria by other means. If I can delay transition by having SRS then why not? I don't see any reason to do it in the other order.

The hoops of the standards of care aren't really obstacles and it's not like you can charge straight to SRS without living some kind of life. It's good to think about it for a bit and make sure its' right, so I say keep the RLE. When I was starting off it seemed like too much, bowing and scrapping to get my way, blah blah the usual. In hindsight the standards of care or whatever they call it today was a pretty minimal impact on my transition and life.

I thought following WPATH was for people asking insurance to pay for their surgeries? I thought people paying with cash could just go to the doctor and get the treatment they want.

In the UK you need to demonstrate social transition has been taking place as a prerequisite for all NHS funded treatment including hormones. This means at least two and possibly three appointments to the GIC. The first of those now typically involves a one-year waiting list. No wonder it causes so much angst, self med and self harm.

At least, that's how the rules and regs are currently interpreted.

Quote from: Devlyn Marie on January 30, 2016, 08:19:20 AM
I thought following WPATH was for people asking insurance to pay for their surgeries? I thought people paying with cash could just go to the doctor and get the treatment they want.

Not my experience. Surgeons wanted some indication that we had been evaluated by a therapist and that we wouldn't regret our surgery.