Thanks for your concern Rita.
I am not trying to rush anything I am merely trying to organise things because I have a very busy life otherwise. I am completely new to any trans community and so I show my ignorance too often, I don't waste time in general, I am returning from my Christmas break to a newly acquired 6 day week job on Monday that entails normal days that start at 6.30am and finish at 5pm and I have been somewhat anti social throughout my life so I don't really care what society in general thinks about me despite my newbie's desire for a passability that comes under my fixed need to be seen as the woman I know myself to be.
But what you have stated makes perfect sense and I have absorbed it with respect and I hope that I have understood it. Especially because you obviously have greater experience in all transgender matters than I do.

Ciao bella,
xoxo,
Roxanne.

I am glad you took my feedback on board. I was.worried you might get the wrong of the stick. Whetever you decide, I wish you the best of luck hun!

Rita

Thanks again Rita and I wish you the best of luck in all your life's endeavors too babe, no matter what they are!
I am aiming for what you beautifully are already, a happy post-op stealth woman and I'm not rushing that, only determined to organise matters as effectively as both my time and ignorance allow! Bye!

xoxo,
Ciao bella,
Roxanne.

Quote from: Ms Grace on January 07, 2016, 01:17:32 AM
I saw Toohey for my "second opinion" letter and I know some people find him a bit old school but honestly I found him to be a very supportive psyche. He sees a large number of trans people on a regular basis - I'd suggest being factual with him, he'll probably try to give you a bit of a lesson about the brain or something but he should be OK. If you have a letter from your counsellor detailing treatment to date it will probably make things go a lot more smoothly.

I've seen Dr. Toohey also and found him lovely and very caring. I suspect some people try to moderate what they tell their therapist, to try and get the outcome they want, which is where the trouble starts. Therapy can only be effective if you're completely honest.

Good luck!

xox
Sami

Quote from: Catherine Sarah on January 06, 2016, 11:44:58 AM
Hi Roxie,

Essentially to go by the letter of the law, Dr. Hayes needs a letter from a licences Psychiatrist stating that after examination he has found no co morbidities or psychiatric conditions that would impede your transition and recommends you for hormone replacement therapy. The rest is up to Jon.

A psychologist is not trained in this type of work to make such a statement.  Have you got a Psych in mind? Do you know Dr.Patrick Toohey, Concord Hosp?? or Dr. Brash Warners Bay?

Huggs
Catherine

Actually I don't think that's correct. WPATH, the new DSM-5, proposed ICD-11 have moved away from requiring an psychiatrist referral for HRT/endocrinologist. I can't find any statement in WPATH that requires a psychiatrist - it only refers to adequate "psychotherapy".

To clarify, psychiatrists are medically trained, and then train in psychology. Psychologists are not medically trained, however are still trained in psychology. Clinical psychologists have attained a Masters in psychology.

I think we need to be careful with the facts here- because there is a bottle-neck in transgendered people getting access to HRT - which is that many endocrinologists will only take referrals from psychiatrists. While this is the case, there is a very real risk that tg people might kill themselves, whereas HRT is known to relieve gender dysphoria.

DSM-5 and ICD-11 are moving to an "informed consent" model.

If I'm wrong then correct me - otherwise let's please be clear on this. If properly skilled psychologists and psychiatrists can refer - this alleviates the bottlenecks

xox
Sami

The bottleneck might also be due to the number of endocrinologists willing and able to take on trans clients, which could be fairly limited even in Sydney.

Quote from: SamKelley on January 22, 2016, 04:54:13 AM
Actually I don't think that's correct. WPATH, the new DSM-5, proposed ICD-11 have moved away from requiring an psychiatrist referral for HRT/endocrinologist. I can't find any statement in WPATH that requires a psychiatrist - it only refers to adequate "psychotherapy".

Bear in mind that there's no legal requirement for doctors to follow WPATH or ICD-11. Whatever Dr Hayes is doing, its his choice.

Hey guys, thanks again for the pool of knowledge that always seems both freely and thoughtfully given. I honestly feel grateful for this.
Where the subjects of this thread are concerned I personally will not be too concerned with the exact legal requirements or phraseologies of these matters. Primarily this is because I am to see Dr Patrick Toohey on Monday and I will be nothing but honest with him because I know that GD has been driving me bonkers for too much of my life. I'm sure I have in no way been alone in this matter. We know when we have felt the woman trapped inside by the male outside. Am I right sisters?
And secondly a person versed in things utterly removed from medical practices, such as myself, would be a fool not to invest some trust in practitioners as highly spoken for as Doctors Toohey and Hayes.

While Monday's appointment is certainly not my first action towards transitioning it is however my first large and concrete step, so at this moment all I can really say is....... PHEW..... I hope it doesn't go awry.

I apologise but I shall leave you girls discussing the exactitudes of this matter while I go out and surreptitiously window shop at some pretty clothes in order to find strength and encouragement for my upcoming ordeals. I am a legal and medical dummy who relatively only wants to look great but nonetheless I know that you are helping me via your experience, care and knowledge and I am honestly grateful for all this (while also being nervous of all that might come).

Ciao,
xoxo,
Roxanne.

Hi Roxie,

Was thinking about you earlier today and wanted to wish you all the best for your appointments next week.

It's a bit late, but my experience was; I didn't find the whole thing quite as scary as I thought it would be.

I can understand why some people find Dr Toohey a bit of a struggle, but he is kind and tolerant.  For me, I was worried that the whole process seemed open-ended, although I was feeling quite vulnerable to start with.  I resolved that it was in my interests to be totally honest and transparent with him, even if I found it shameful or humiliating.  It seemed as if Dr Toohey had exhausted all the questions he had, and still didn't give me any diagnosis or determination, and so I kept turning up to appointments after I felt we had run out of things to talk about.  Eventually I started to feel a little exploited, so I became a bit more assertive, and asked directly whether he had sufficient information and would provide me an endorsement or not.  He told me he had no reservations, and the letter of endorsement arrived very promptly.

I've also spoken to Dr Scott on the phone.  He was very open and direct and made me feel very comfortable.  Even on the phone, he made it clear to me what information he needed and how much time we would need to spend together for him to make a determination.  If I need further referrals or letters, he would probably be my first choice, although I would be ok going back to Dr Toohey also.

I found Dr Hayes amazing.  He never actually asked for the pysch endorsement letter, and when I volunteered it towards the end of the appointment, he never even read it, just popped it in the file.  I found him to be the most compassionate, understanding, humane medical provider I have dealt with so far.  He was much more concerned about my experiences in my own words than a psych's interpretation of them.  Ironically, Dr Hayes was the most affordable appointment in my medical transition, and I left feeling human, dignified, prepared, and informed when leaving his clinic.

I have my first follow-up with Dr Hayes next week.

All the best for your appointments next week.  Thinking of you.

P.S.  Have you seen The Danish Girl yet?  What did you think?

I concerned with the technicalities of it all because its caused me a great deal of problems over the years. Or perhaps I should say I've caused myself a great deal of problems though misunderstanding how it all works. A lot of common knowledge is just plain wrong, not applicable to Sydney, or not to my situation.

Quote from: Claire_Sydney on January 22, 2016, 09:23:56 PM
I have my first follow-up with Dr Hayes next week.

Are you getting implants? They are the best, but I don't know if he does those to start off with.

Quote from: SamKelley on January 22, 2016, 04:54:13 AM

Quote from: Catherine Sarah on January 06, 2016, 11:44:58 AM
Hi Roxie,

Essentially to go by the letter of the law, Dr. Hayes needs a letter from a licences Psychiatrist stating that after examination he has found no co morbidities or psychiatric conditions that would impede your transition and recommends you for hormone replacement therapy. The rest is up to Jon.

A psychologist is not trained in this type of work to make such a statement.  Have you got a Psych in mind? Do you know Dr.Patrick Toohey, Concord Hosp?? or Dr. Brash Warners Bay?

Huggs
Catherine

Actually I don't think that's correct. WPATH, the new DSM-5, proposed ICD-11 have moved away from requiring an psychiatrist referral for HRT/endocrinologist. I can't find any statement in WPATH that requires a psychiatrist - it only refers to adequate "psychotherapy".

To clarify, psychiatrists are medically trained, and then train in psychology. Psychologists are not medically trained, however are still trained in psychology. Clinical psychologists have attained a Masters in psychology.

I think we need to be careful with the facts here- because there is a bottle-neck in transgendered people getting access to HRT - which is that many endocrinologists will only take referrals from psychiatrists. While this is the case, there is a very real risk that tg people might kill themselves, whereas HRT is known to relieve gender dysphoria.

DSM-5 and ICD-11 are moving to an "informed consent" model.

If I'm wrong then correct me - otherwise let's please be clear on this. If properly skilled psychologists and psychiatrists can refer - this alleviates the bottlenecks

xox
Sami

A couple of points, while clinical psychologists letters are accepted it is up to the endocrinologist to make their own determination as well. Some endos and surgeons are reluctant to accept an opinion from a psychologist that they do not know the competency of. Since the provider takes the legal risk then they make their own judgement based on their knowledge of the situation.

Their is a real shortage of endocrinologists and a reluctance by GPs to give HRT, that needs to change. My GP now looks after my HRT but she has access to an endocrinologist for advice if she is unsure of anything.

Informed consent is not hormones on demand. That is often misunderstood. The informed consent model in Adelaide take a total of one hour and 45 mins spread over three sessions, but the bottleneck is getting the first appointment due to demand.

Quote from: Cindy on January 23, 2016, 12:39:10 AM
Informed consent is not hormones on demand. That is often misunderstood. The informed consent model in Adelaide take a total of one hour and 45 mins spread over three sessions, but the bottleneck is getting the first appointment due to demand.

I've only really heard about informed consent in the USA, and I have the impression there is that it is on demand. I've very mixed feelings about that, even though I would want it on demand for myself.

Adelaide sounds like its using the proper medical definition of informed consent.

I'm curious, what model is used in Sydney?

Quote from: AnonyMs on January 22, 2016, 10:43:53 PM

Are you getting implants? They are the best, but I don't know if he does those to start off with.

We did discuss it, and it sounds like an effective delivery method (and perhaps a bit easier on the liver?) 

I'm only taking estrogen tablets at the moment, so I think the plan is to introduce an AA next week.  Perhaps after I've adjusted to that a bit.

BTW, I few things I forgot to ask - Do the implants completely break down, or does some residue have to be removed afterwards?  Do you have ongoing pain/tenderness at the implant site?  Do you go back to the endo for regular replacements, or does your GP monitor your bloods and inject them for you in the long term? 

Thanks AnonyMs !

Quote from: Claire_Sydney on January 23, 2016, 01:04:07 AM

Quote from: AnonyMs on January 22, 2016, 10:43:53 PM

Are you getting implants? They are the best, but I don't know if he does those to start off with.

We did discuss it, and it sounds like an effective delivery method (and perhaps a bit easier on the liver?) 

I'm only taking estrogen tablets at the moment, so I think the plan is to introduce an AA next week.  Perhaps after I've adjusted to that a bit.

BTW, I few things I forgot to ask - Do the implants completely break down, or does some residue have to be removed afterwards?  Do you have ongoing pain/tenderness at the implant site?  Do you go back to the endo for regular replacements, or does your GP monitor your bloods and inject them for you in the long term? 

Thanks AnonyMs !

They break down completely over 6 months or so, after the wound has healed there is no tenderness ( you often need a stitch to close the incision), yes the end replaces them every 6 months or so after they get use to your hormone levels which vary a bit between individuals.

Implants do completely breakdown and there is nothing to be removed (that would be bad!).

You get regular blood tests to show you blood levels and when it goes below 800 pmol/L you get a new one.

After a few of them it will be clearer how long they will last you. Everyone is different. You need to go back to Dr Hayes for the next one. I've not heard of a GP doing it, but after seeing Dr Hayes there's no way I'm letting a GP anywhere near me.

Its a minor surgical procedure. There's been descriptions in the past on the forums (I've made some). Its got a bit easier recently as he's changed the size of the implants. Do some searching.

I find them far superior to what I've had before. I think mine last about 9 months, perhaps more. I can basically forget I'm taking medication, and I like that. You don't need to stop HRT for SRS either, which is a nice advantage if you want that.

Thanks again Claire and Ms. I feel wonderfully emboldened knowing that you have been thinking of me Claire, that is nothing short of amazing! My Gender Centre counseller telling me of this website has been an unsullied source of beauteous  awakening for me because of gorgeous women like you!
Unfortunately I am "coming in from the cold" so to speak and I have thus had no prior knowledge of what, or who, is around to help us. All I've ever had has been a burning necessity and my beaten up lap-top to find ways to sources of aid until I came upon you guys. I didn't really even know that transition was likely to be possible until a little more than a year ago when I struck HRT timelines on Youtube. I WAS DUMBSTRUCK. Prior to that all I knew of were people like Danni La Roux(?), Carlotta and Ru Paul. And myself in my dreams. Which all had to be kept very secret.
To make matters considerably worse I too often ignore mainstream media because I find that it, for the most part, dribbles on about the status quo. But because I ignore it I missed out on the societal advent of girls like Jazz and women like Caitlyn . Additionally my own lifeway has buried my freedom under (what is to me) a stagnant pile of testo driven dishonesty because I have been raised to the belief that what I have been doing is "what blokes do".
Please realise I AM NOT SEEKING SYMPATHY, I AM ONLY LETTING MY BEAUTIFUL SISTERS KNOW WHERE I AM COMING FROM and no doubt MANY OF MY SISTERS HAVE SUFFERED MUCH, MUCH WORSE than I.

At least I will be armed with the knowledge that my appointment with Dr Toohey will shortly be followed by my initial consultation with Dr Hayes and this might provide some honest and medically sanctioned leverage for my own case. Just a hope but so far Dr Toohey has been nice to me (I've had to speak directly to him because he has been answering his own phones and stuff lately) and I'm supported by a really, really great letter from my Gender Centre counseller who has been a HUGE HELP to me.

I am currently working in a job that requires long hours, 6.30am-5pm, six days a week which I am hoPing to hold until August-November by which time I will have saved the dollars necessary for FFS, SRS and maybe even BA but I don't need BA like I need FFS or SRS. But I've been thinking more and more about boobies lately. This doesn't mean I am hoping for these surgeries in this time as I know I must at least bestride the path of my necessary biological road.

Claire I have been unable to see The Danish Girl yet because of the reasons given directly above about my working hours but I will soon! I hear that it is very sad despite the fact that you are helping to dispel the sadness caused by me feeling alone.

Ms. I will be asking Dr Hayes for implants thanks to advice you have already given me. Gel or patches won't work because my job can often lead to strenuous and sweaty activities and pills/tablets might not be given for whatever reasons.

Anyway thanks again
ciao mia sorelle,
xoxo,
Roxanne.

It's highly unlikely he'll start you directly on implants - you'll probably need (at the very least) six weeks on a starting course of pills to get your biology accustomed to the estrogen. In large part it will be down to your current health, fitness (things like weight, age, blood pressure, blood sugar, cholesterol, liver function, kidney function, etc), family health history and so on.

Quote from: roxie rudi on January 23, 2016, 01:21:55 AM
Ms. I will be asking Dr Hayes for implants thanks to advice you have already given me. Gel or patches won't work because my job can often lead to strenuous and sweaty activities and pills/tablets might not be given for whatever reasons.

Generally not recommended over 40 years of age.

It probably depends on health factors - I was 47 but he started me on on pills. After six weeks he added a gel. From memory I went onto implants after 12 weeks and dropped the pills and gel. Someone I know who is over 50 was started on gel or patches (can't remember which), went onto an implant after ten weeks I think.

My understanding of the gel is that it is absorbed very quickly. I was concerned about sweating too but he said that it wouldn't be an issue.

Thanks Grace. I should be okay, my bloods are "perfect" according to my gp, Dr Santos who often works with Dr Hayes and furthermore I have always been, and still am, keenly aware of my fitness and health because of congenital heart defects that I had to have surgically rectified when I was seven. I don't smoke, I go to gym three times a week despite working loooong hours, I rarely drink and I haven't indulged in  drugs for years.
I have no worries in this matter regarding my health or fitness. I'm only waiting to see my cardiologist so that he can get my okays ready for eventual surgeries with Dr Suporn.