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The Ethics of Gatekeeping - or why the RLE test is problematic

Started by RachelsMantra, November 25, 2015, 03:11:40 PM

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suzifrommd

Quote from: Lagertha on November 26, 2015, 08:48:18 AM
There is evidence that some people detransition (for various reasons). Should we do SRS first, and then evaluate if it's the right decision, or it might be better the other way? And yes, RLE and hormone therapy has proven to be exactly the real life test which helps you to see if transition is the right decision or not.

Can you point me to those studies that prove that RLE helps people decide? I haven't come across any but I'd love to see them.
Have you read my short story The Eve of Triumph?
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AnonyMs

It's easy to say what people should or shouldn't to, but I have very good reason to want SRS before RLE, and maybe never RLE. And I'm not crazy, at least not according to my psych.

To say there's hard and fast rules is grossly unfair, and will lead to people being severely hurt. I'm not willing to let people threaten my life like that, and fortunately I'm in a position to do whatever I want. So many are not and I feel for them.
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cindianna_jones

I needed the real life test as I called it. I needed to know I could function in society. I needed to know I could hold a job and be respected in my profession. I waited 18 months. I wanted to do it sooner but Dr. Biber had an accident. I know that one year seems rather arbitrary for some of us.

I do think it is a good idea to get out in the world as our true selves before making such a permanent commitment. As for the time period, I'm not so sure. If I could have had the surgery once I was sure where my life was headed, I would have done so. But I don't think that waiting hurt me in the grand scheme. It has been over thirty years since I started my transition. As I look back at that time, the wait seemed to take forever but I've had a rich life so far and that was such a short period.

As for this particular case under discussion? Everyone has their own challenges to face. It is our own responsibility to take them on and deal with them. We make mistakes along the way. But we must make these things ours and not blame the system or other people for our problems. It's not easy. But it is doable.

Chin up,
Cindi
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Lagertha

Quote from: suzifrommd on November 26, 2015, 09:37:46 AM
Can you point me to those studies that prove that RLE helps people decide? I haven't come across any but I'd love to see them.

I don't need to see a study to realize how many people choose to stop transition or detransition, either after a month or few months, or year or two or more... You can have a read on this forum and others, or watch detransition videos on youtube, or meet people at local group. What else could it be than real life experience which makes people to realize that this is not for them (for whatever reason you can think of)?
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Michelle-G

I think the author is looking at this the wrong way. RLE is not something that is a barrier to transition. It IS transition. You say that you're living in the wrong gender? Then go and live in the right one. Today. Now. Go do it. It's called RLE.

People have this notion that transition begins with GRS. That's nonsense. Transition is like any other journey. It begins when you start it. During my RLE nobody questioned my gender or treated me as anything other than a woman, and my transition really became real with RLE. GRS didn't change a thing for me except make me happy(er).

And what of non-op trans folks? Are their real life experiences invalid? Hardly. Is their life without surgery not RLE?

People need to quit blaming WPATH for giving the medical community a treatment protocol they can use to help people. The medical schools haven't done it, so this is helpful.

If RLE is a burden then don't do it. Find a doctor who subscribes to the informed consent model ( http://www.icath.org ) and just transition without RLE. No worries.
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AnonyMs

Quote from: Michelle-G on November 28, 2015, 07:26:16 AM
If RLE is a burden then don't do it. Find a doctor who subscribes to the informed consent model ( http://www.icath.org ) and just transition without RLE. No worries.

I might agree if we could make just one small change.

"If RLE is a burden then don't do it. Find a doctor surgeon who subscribes to the informed consent model and just transition without RLE. No worries."

The other problem is that informed consent is not very common around the world.
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Oliviah

Quote from: AnonyMs on November 26, 2015, 09:45:10 AM
It's easy to say what people should or shouldn't to, but I have very good reason to want SRS before RLE, and maybe never RLE. And I'm not crazy, at least not according to my psych.

To say there's hard and fast rules is grossly unfair, and will lead to people being severely hurt. I'm not willing to let people threaten my life like that, and fortunately I'm in a position to do whatever I want. So many are not and I feel for them.
I think I need understand where you are coming from better.

By real life experience you mean living full time in the new gender role right? Do you present at all? 

How do genitals which people cannot see help where living full time doesn't?

I am am not saying there are not good reasons for surgery before presentation but I can't think of any.
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Peep

Quote from: Oliviah on November 28, 2015, 08:30:31 AM
I think I need understand where you are coming from better.

By real life experience you mean living full time in the new gender role right? Do you present at all? 

How do genitals which people cannot see help where living full time doesn't?

I am am not saying there are not good reasons for surgery before presentation but I can't think of any.

from a ftm point of view, and going on what i've read and been told by doctors about the system I'm in, RLE seems to be required for chest surgery, but its hard to present as male accurately to get the 'experience' in the first place without it. I'm always going to have to be female at the gym for example, because I can't walk fast in a binder + breathe, let alone cycle or run, and if i raise my arms above my head my chest becomes obvious. Any tighter a bind and it's physically dangerous.

I've also been told i need to do RLE before hormones too - and I'm not sure that i want them so i don't mind, but from the point of view of 'experience', there's no way to experience the unpredictable changes of hormones. If i could simulate them in some way i wouldn't need them? Up until i gain access to treatment, i'm experiencing life as an androgynous leaning to female with a lot of body anxiety issues, regardless of what clothes i wear or what pronouns i ask for. That doesn't seem like an accurate test to me!

I've got no objection to being told to take the time to decide that I want changes that are irreversible, but I don't think the emotional and physical risks of being chucked out there with no help are worth it. It feels like the 'experience test' causes more problems than it solves.

As for post surgery regret, that seems like it'll always be a possibility regardless of how long one waits first. You could be sure since you're 6 that you want babies, and regret the decision once the reality hits, pregnant at 30! That's just part of life.
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Lagertha

You don't need RLE to have ftm top surgery. You are dealing with gatekeepers. You can find a surgeon who will do a surgery with informed consent. Much like any cisgender male person, or crossdresser, can have breast implants done. You dont have to be transsexual or transgender to have breasts removed, or augmented. Not every surgeon will be willing to do it, but some will.

What we are talking here having RLE before genital reconstruction surgery. 

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Oliviah

Quote from: Lagertha on November 28, 2015, 09:56:09 AM
You don't need RLE to have ftm top surgery. You are dealing with gatekeepers. You can find a surgeon who will do a surgery with informed consent. Much like any cisgender male person, or crossdresser, can have breast implants done. You dont have to be transsexual or transgender to have breasts removed, or augmented. Not every surgeon will be willing to do it, but some will.

What we are talking here having RLE before genital reconstruction surgery.

This.  Top surgery for both mtf and ftm doesn't require RLE.  They are considered regular comedic surgery.  I male is allowed implants and female mastectomy just buy buying them.  Now getting them covered as gender confirming might be where you are having the problem I guess?
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diane 2606

Quote from: Cindi Jones on November 26, 2015, 10:08:37 AM
I needed to know I could function in society. I needed to know I could hold a job and be respected in my profession."

^^^^^^^ THIS

During my RLE (Feb '94 - Mar '95) I found that I could function professionally, and have a life where new acquaintances, who didn't know me from before, accepted me as I presented myself — no questions asked. These are real, life-affirming milestones. I benefited by knowing I could survive in the real world as a woman. Today, within my circle of friends and acquaintances, no one knows anything about my first 48 years of life.

At this point in time, being trans is celebrated in the media. That won't last; nothing does. RLE is about establishing an identity as the gender (not assigned at birth) that will last a lifetime. If you're only interested in being the local ->-bleeped-<--de-jour for the rest of your life, have surgery on day 0.

My Résumé
I'm the new woman here, the n00biest of all n00bs. Body by Schrang in 1995. No regrets. I'll make an effort not to violate local taboos.
"Old age ain't no place for sissies." — Bette Davis
Social expectations are not the boss of me.
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AnonyMs

Quote from: Oliviah on November 28, 2015, 08:30:31 AM
I think I need understand where you are coming from better.

By real life experience you mean living full time in the new gender role right? Do you present at all? 

How do genitals which people cannot see help where living full time doesn't?

I am am not saying there are not good reasons for surgery before presentation but I can't think of any.

The key point is that I can, and even if no one else understands or agrees it doesn't matter. What I want is what's important. All else is gate keeping.

For the sake of discussion though I'll try to explain. I'm M2F, and I present male due to family and work issues. Typical stuff. I'd been on low dose HRT for years, and last year I had very bad depression and couldn't take it anymore. I started on a full transitioning level of HRT and that's made me feel great.

If I socially transition its likely to cost me badly and I want to avoid it. I'm sure we all do, but I'm really stubborn and I absolutely refuse to socially transition unless there's no other choice. This is not the right time in my life. Later would be so much better.

So HRT has helped a lot, but it helped a lot when I first started and that didn't last. Without social transition there's one more thing that I can do that might help and that's SRS. If it comes to it that's what I'll do, and hope for the best.

You could say that I've done RLE; I intend to present male after SRS, and I've plenty of practice at that. It's not what people mean though.

There's a slight possibility that I'm non-binary, but I don't think so. It also doesn't matter either way.

I can and will do this. I understand why so many others can't, and all I can say is that it doesn't apply to me.

I keep arguing this point not for myself, but because I've suffered a lot getting to where I am now and it upsets me to see others struggling with it.
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Oliviah

Quote from: AnonyMs on November 28, 2015, 12:14:39 PM
The key point is that I can, and even if no one else understands or agrees it doesn't matter. What I want is what's important. All else is gate keeping.

For the sake of discussion though I'll try to explain. I'm M2F, and I present male due to family and work issues. Typical stuff. I'd been on low dose HRT for years, and last year I had very bad depression and couldn't take it anymore. I started on a full transitioning level of HRT and that's made me feel great.

If I socially transition its likely to cost me badly and I want to avoid it. I'm sure we all do, but I'm really stubborn and I absolutely refuse to socially transition unless there's no other choice. This is not the right time in my life. Later would be so much better.

So HRT has helped a lot, but it helped a lot when I first started and that didn't last. Without social transition there's one more thing that I can do that might help and that's SRS. If it comes to it that's what I'll do, and hope for the best.

You could say that I've done RLE; I intend to present male after SRS, and I've plenty of practice at that. It's not what people mean though.

There's a slight possibility that I'm non-binary, but I don't think so. It also doesn't matter either way.

I can and will do this. I understand why so many others can't, and all I can say is that it doesn't apply to me.

I keep arguing this point not for myself, but because I've suffered a lot getting to where I am now and it upsets me to see others struggling with it.

The medical profession is first to do no harm.  That is their ethos.  Surgeons shouldn't be cutting up people with out good cause.  If someone isn't going to present IMHO there should be no surgery.  It sounds like a suicide based in regret waiting to happen.

There are certainly doctors who would agree with this philosophy as I have seen people dye their eyes red and implant things to look like demons and what not.  If you want that kind of medical care be prepared for less than perfect results.  If you want a skilled ethical professional expect them to act like one.

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Dena

Welcome to Susan's Place diane 2606. I am post 33 years and we need more people around here who have had the long view of post surgical life. I know you are secure in your new life but if there is anything I can help you with, let me know.

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AnonyMs

Quote from: Oliviah on November 28, 2015, 12:28:41 PM
The medical profession is first to do no harm.  That is their ethos.  Surgeons shouldn't be cutting up people with out good cause.  If someone isn't going to present IMHO there should be no surgery.  It sounds like a suicide based in regret waiting to happen.

There are certainly doctors who would agree with this philosophy as I have seen people dye their eyes red and implant things to look like demons and what not.  If you want that kind of medical care be prepared for less than perfect results.  If you want a skilled ethical professional expect them to act like one.

We'll have to agree to disagree.

I can get a good surgeon. I'm exceptionally good at problem solving.
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suzifrommd

 :police:

A reminder that this site needs to be a safe place for all trans people and that there are many ways to be trans and many ways to transition. A statement that one has more validity than another is a direct violation of item #10 of the Site Terms of Service. Comparison of transition related medical care to cosmetic procedures strays dangerously close to a violation of #9.

Thread locked.
Have you read my short story The Eve of Triumph?
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