I've seen quite a few posts from members reminding people that living as the chosen gender for over a year is a requirement for gender confirming surgeries, but that was a while ago at least in the U.S. I thought the Real Life Test was deemed inhumane when it was part of HBIGDA before it became WPATH. Soooo, am I wrong or something? I know there are surgeons in the states willing to operate on 16yr old and older kids with parent approval as well as waiving part of the letter requirement on a case by case basis. It just seems odd that people keep saying something I'm positive isn't true where I live.....


     Hugs,
- Katie
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Yup, still a thing unfortunately.  It's the only thing holding me back from surgery right now, so it's a bit of a raw point with me.  I have everything else in place - letters, the whole lot - but god forbid I haven't strutted around as a full-time female for an entire year...

I do see the upside of it; GRS is a huge change, and at least knowing what one is getting into from a societal standpoint is important.  But given that GRS is just about the one change in our entire transitions that can be kept entirely private (hormones are on public display, name changes too, clothing, etc.), I don't see the need for an entire year of 100% proven RLE.  I'd much prefer this to be rolled into the psych letters for surgery with a paragraph about how the patient has demonstrated full awareness of the magnitude of the surgical changes and has demonstrated the means to accommodate those changes into his or her life.

I've been part time for a long time, and 90% full time for a long time too.  In total, waaaay more than a year.  I've almost been full time 100% (like, literally emptying my life of everything male) for a year, so that hurdle will be jumped over soon enough.

Unlikely to change anytime soon though.  But at least it's not going back to the really bad old days when RLE was a prerequisite for hormones.

Here's what's written in my WPATH V7:

QuoteCriteria for metoidioplasty or phalloplasty in FtM patients and for vaginoplasty in MtF patients:

1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless
hormones are not clinically indicated for the individual).
6. 12 continuous months of living in a gender role that is congruent with their gender identity.

Pretty much all the decent, reputable GRS surgeons also require the one year RLE too, although how they want this documented seems vague.

It's certainly still in the WPATH standards of care, and surgeons still require two letters. Is it possible to get two letters without doing RLE? Probably, if you shopped around a bit.

If you think about it there probably are ways around the RLE. But I personally believe that it is a good thing. It gives potential transitioning folks and their doctors that last boundry for them to make a really serious decision. I disaprove of that it goes for such a lengthly period though. It is too long.

Quote from: suzifrommd on September 13, 2015, 08:55:10 AM
It's certainly still in the WPATH standards of care, and surgeons still require two letters. Is it possible to get two letters without doing RLE? Probably, if you shopped around a bit.

This is going to show how old fashioned I am, but, I believe that there was once a fast track approach in the standards for people who have already been living full time for a long time and just wanted to come in and get the surgery. It used to be that many would take street hormones and live as women for years until they could finally afford to get surgery. Nowadays I believe that the medical profession is a little more in tune with the world and this might be dying off in more advanced countries but still the norm in 3rd world countries.

It's no longer RLT, it's RLE. No "test", just a specific length of experience living in your correct gender. If mental health folks were sensible, they'd get to know you and see if it makes sense as far as your goals go. That is basically what the therapist who wrote my top surgery referral did, and he has said that he would do the same whenever I felt I was ready for bottom surgery.

I really don't think I had an "RLT' or "RLE". I always dressed up like a guy, my mannerisms were always pretty masculine. I had a few sessions with my Gender Therapist and on my last one before she gave me my letter to start hormones she took me to a Starbucks and treated me because I helped her get those water fountain jugs for the office. I guess that was my "RLT" haha. She deemed me a true gentleman

My top surgeon told me I could get a letter from my endo and that would be enough for me to go forward with. So I got that very easily and was able to have my surgery in July.

I think the RLE is good because it allows one to grow into being whatever their gender is and gives time for issues like family, job and other stuff to be sorted out.

I think I read on some post on here that a legal name change was accepted as legal documentation as having started RLE. So, for anyone starting out... I guess getting a name change somewhat early on wouldn't be a bad idea since legally speaking, even if you presented as male (or female if you're FtM) then it'd legally count.

You might check in your area and see if that's the case.

I have an intense dislike of RLT and its caused me a great deal of anguish. Doing RLT would likely turn my life upside and I don't feel a strong need to present female. I do feel some need for SRS on the other hand.

Quote from: StartingOver on September 13, 2015, 06:21:01 AM
Yup, still a thing unfortunately.  It's the only thing holding me back from surgery right now, so it's a bit of a raw point with me.  I have everything else in place - letters, the whole lot - but god forbid I haven't strutted around as a full-time female for an entire year...

If you have the letters have you tried asking the surgeon if he'll accept them? My understanding is that most of them don't care about anything except you having the letters. They are not qualified to evaluate you and its not their job. On top of that, like HRT, these letters are not a legal requirement and the surgeon can accept whatever they want, including no letters at all.

A lot of surgeons have a really long waiting list and my favorite, Suporn, is close to a year. You might end up doing a year of RLE anyway if you've not booked already.

Quote from: ftmax on September 13, 2015, 09:45:04 AM
It's no longer RLT, it's RLE. No "test", just a specific length of experience living in your correct gender. If mental health folks were sensible, they'd get to know you and see if it makes sense as far as your goals go. That is basically what the therapist who wrote my top surgery referral did, and he has said that he would do the same whenever I felt I was ready for bottom surgery.

I believe the technically correct term is RLT and and politically correct term is RLE. If you don't serve out your year then you don't get the letter, which makes it a test in my mind.

Quote from: StartingOver on September 13, 2015, 06:21:01 AM
Yup, still a thing unfortunately.  It's the only thing holding me back from surgery right now, so it's a bit of a raw point with me.  I have everything else in place - letters, the whole lot - but god forbid I haven't strutted around as a full-time female for an entire year...

I do see the upside of it; GRS is a huge change, and at least knowing what one is getting into from a societal standpoint is important.  But given that GRS is just about the one change in our entire transitions that can be kept entirely private (hormones are on public display, name changes too, clothing, etc.), I don't see the need for an entire year of 100% proven RLE.  I'd much prefer this to be rolled into the psych letters for surgery with a paragraph about how the patient has demonstrated full awareness of the magnitude of the surgical changes and has demonstrated the means to accommodate those changes into his or her life.

I've been part time for a long time, and 90% full time for a long time too.  In total, waaaay more than a year.  I've almost been full time 100% (like, literally emptying my life of everything male) for a year, so that hurdle will be jumped over soon enough.

Unlikely to change anytime soon though.  But at least it's not going back to the really bad old days when RLE was a prerequisite for hormones.

Here's what's written in my WPATH V7:

Pretty much all the decent, reputable GRS surgeons also require the one year RLE too, although how they want this documented seems vague.

Yeah the how it's documented part really annoys me. I've been living "as the gender role that is congruent with my gender identity" for more than three years now but I haven't made any official documentation of it. I'm calling my psych monday to schedule an appointment for my first letter so I guess I'll find out then.

Quote from: Lady_Oracle on September 13, 2015, 04:38:28 PM
Yeah the how it's documented part really annoys me. I've been living "as the gender role that is congruent with my gender identity" for more than three years now but I haven't made any official documentation of it. I'm calling my psych monday to schedule an appointment for my first letter so I guess I'll find out then.

I guess i figured that because it is literally impossible to document a year's worth of living in your chosen gender, that that aspect of the WPATH requirements was fudgeable. I know that while it isn't recommended, you can transition in stealth, and I was under the impression that the documented transition time was used as the hard and fast 1yr rule, i.e. if you started medical transition 6 months ago, surgeons would prefer to wait until you are further along the process so they don't risk performing surgery on someone who might choose to detransition.

I guess I just didn't realize this was a concrete rule some of y'all had to deal with, since I'm only worried about spending too many years on spiro and hurting my liver before I have time for my surgery and recovery.

Quote from: Obfuskatie on September 13, 2015, 05:55:42 PM
I guess i figured that because it is literally impossible to document a year's worth of living in your chosen gender, that that aspect of the WPATH requirements was fudgeable. I know that while it isn't recommended, you can transition in stealth, and I was under the impression that the documented transition time was used as the hard and fast 1yr rule, i.e. if you started medical transition 6 months ago, surgeons would prefer to wait until you are further along the process so they don't risk performing surgery on someone who might choose to detransition.

I guess I just didn't realize this was a concrete rule some of y'all had to deal with, since I'm only worried about spending too many years on spiro and hurting my liver before I have time for my surgery and recovery.

Yep like that's my concern too, I'm on a high dose of spiro and would like to get off it sooner than later. I can't stand the side effects minus the t being blocked lolol. I have been on hrt for 3.5 years now so I definitely pass that one year rule. I guess I don't have much to worry about honestly. Once my psych sees me she'll probably give me my letter immediately just like she did for hrt. I didn't even get a letter to start hrt, she made a phone call to my endo and that was it. There's more to that story but yeah by the time I saw a psych I was already two years into my transition and she saw that I had already worked through the coming out stuff and the early transition stuff too so I was more than ready to start hrt, just like I'm more than ready for grs.

Here's a YouTube video about getting SRS letters in Sydney. One psych session.

Transgender SRS Psychiatrist visit for APPROVAL! Australia , by Jacinta Andrews


From her previous video's I think this is Dr Michael Scott of Neutral Bay.

I will never understand why this is a controversy.  It's a year.  Do you realize how fast that goes by? Wouldn't you want to take a year anyway to make sure living in your new gender role actually fits you before doing something that can't be reversed?

Yeah in the grand scheme of things, a year isn't much time but for some that could be an eternity. Idk my heart goes out to non binary folks. I'm a part of the binary so the psych evaluations and stuff aren't difficult since I fit the "criteria"

I do wonder if it's something I will be asked to do.

Short of gluing on a fake 'tache and telling everyone to call me sir I can't see how my regular life could be any different living as male in RLE. Seriously, I've been living this way for half a decade, I wonder what on earth I could do to make it any more "real". 

I don't think that cisgender people know best about the needs of transpeople at all.  They have created a one-size-fits-all solution for a problem that is unique to all of those who suffer it.  Some people probably should do a year (or even several years) of this before committing to irreversible surgery, but I think it should me merely a suggestion. 

My body. My rules. 

I just don't understand exactly what they mean by "living in role". is it just name change, asking people to use your correct pronouns and making an effort to pass? Or will they look for gender specific hobbies or whatever?

I don't think I'll ever pass without hormones or top surgery, and if i can't get those if i don't pass, then what am i meant to do?

I'm a little confused too.
Is RLE required for both HRT and surgeries? Or just surgeries only?

If RLE is required for hormones, then how does one prove that they're living as the other gender for an entire year? Just by name changes and that's it?