Quote from: kira21 ♡♡♡ on February 01, 2016, 10:32:32 AM
SRS has some of the lowest regret rates of any surgery.  By putting psych evaluations as mandatory for it,  when they are not for equally life changing medical procedures such as ivf,  you are saying that we are not capable of making our own evaluations.  Then there is the issue of the  fact that wearing a skirt doesn't prepare you for having a vagina.

IVF is nothing like GRS.  Yeah regret is low, but that is because largely to gate keeping.  I know it is triggery to some people to even consider the fact a lot of people now a days are doing this all for very wrong reasons, but it sure is true.  Those people should not get GRS and will regret it.  Those people currently are not getting it due to gate keeping.  If it isn't your identity a doctor is doing harm to alter you.  Their oath is do no harm. 

Locked for review.

 
Okay folks, we may not agree or understand why somebody wants to do certain things. However that doesn't give us an open invitation to criticize their reasons or make them seem less legit. Let's keep in mind TOS 9, TOD 10 and TOS 5.
Thanks
Mariah

Thread unlocked.

Quote from: Oliviah on February 01, 2016, 10:36:43 AM
IVF is nothing like GRS.  Yeah regret is low, but that is because largely to gate keeping.  I know it is triggery to some people to even consider the fact a lot of people now a days are doing this all for very wrong reasons, but it sure is true.  Those people should not get GRS and will regret it.  Those people currently are not getting it due to gate keeping.  If it isn't your identity a doctor is doing harm to alter you.  Their oath is do no harm.

IVF is not nothing like SRS,  it's exactly alike SRS in regards to the factors that I was comparing it...  It is life changing and a medical intervention. TBH i think a psych evaluation might be more useful for IVF.

I doubt very much that you could find any evidence to support the assertion that low regret rates are due to gate keeping.  The original wpath guidance on this wasn't even created with evidence to support it.

I have no vested interest in this, I am post op.  I don't think wearing  a skirt, pandering to someone else's notion of what 'living as a woman' entails,  would help prepare anyone for having a vagina.

Can rle even be defined? To define living as a woman,  one has to be prescriptive about how women should live and that's not right as women live in all sorts of ways.  Women can wear mens clothing, have names used by men,  I know women,  cis women who wouldn't pass this test. They have vaginas and it didn't do them any harm. Seriously, what is rle?  How does one show that one is 'living as a woman' ? Clothing? Long hair and make up? Feminine mannerisms? They don't make a woman. About the only concrete thing is having your gender marker changed on your passport and that doesnt prepare you for surgery.

What is IVF?

I have a dollar that says in vitro fertilization?

That's all I could come up with.  Still would like another option because the similarities are questionable.

Like, if I did IVF and had a baby I could give it up for adoption if it was beyond my capabilities to handle.  I couldn't do that with a vagina....

Thanks Devlyn

Hugs

Jen

I had worked in my role before seeking out my letters. I had known the two mental health professionals for a few months prior. I performed some volunteer work for them. One taught at a community college and I served on a panel for her sex ed classes covering our favorite subject. For the other, I helped moderate a support group which met once a week.

In both cases, they trusted me when I told them that I had been living the role for the required time period. I did not lie but I was right on the schedule. I couldn't wait to get under the knife. I'm sure that the requirements are more stringent now since some insurance companies and health care plans now cover the surgery.

I voted for RLE for this reason: I'd like to see GRS available to all who need it, to be covered  by all insurance, or by your nation's health care plan. Medical professionals really need protection for the services they perform and this is a big one. If they can point to stringent standards and a high rate of success, then the procedure could and should become mainstream. I believe this trumps what we want for ourselves in that it is good for everyone. We need better acceptance in society. We need the medical evidence of success and the support of the medical services community.

Personally, at the time I transitioned thirty years ago, I thought it was all a bunch of bunk. I've since changed my mind.

Cindi

Cindi

Sure you could give it up but that has pretty serious  consequences too! And many many people would not and even if they do, the pregnancy is pretty serious too! 

It's just an example I have seen used before of one of several other procedures that has important  consequences, that requires no psych evaluation. It's used as an indication that people often make important decisions about their lives, including in medical settings without the need for psych evaluation.

Quote from: Cindi Jones on February 01, 2016, 04:01:16 PM
I voted for RLE for this reason: I'd like to see GRS available to all who need it, to be covered  by all insurance, or by your nation's health care plan. Medical professionals really need protection for the services they perform and this is a big one. If they can point to stringent standards and a high rate of success, then the procedure could and should become mainstream.

But shouldn't they be required to prove that RLE somehow contributes to that high rate of success?

So far, I've seen no such proof. On the contrary, all the evidence I've seen is that RLE has no relation to post-surgical satisfaction.

Someone said WPATH is living in the past. That's undoubtedly true. I think what has to be remembered is the members are steeped in science. Absent scientifically derived evidence showing RLE is a waste of time, nothing will change. Either scientifically prove your hypothesis, or get over it.

I think part of our issue has to do with calling the MtF operation Gender Reassignment (or Confirmation) Surgery. Our gender is who we are; it's what's between our ears, what we know of ourselves. To us, there's no doubt about our gender, and no surgical procedure can enhance that. Whether we present as femme-fem or butchy-butch, our gender is our gender.

Conversely, walking around with an exposed vagina isn't how society classifies one's sex (that's sex as in the marker on your driving license) as female. Our sex, generally defined as genitalia, can be changed with a surgical procedure which some of us feel is our (constitutional/god given — take your pick) right to have on demand. But it won't make society classify us as woman, rather than man, because it's invisible unless naked.

So I'm torn. I get there are gender-queers who should have every right to a body of their choosing. But there are also those who intend to socially transition, and SRS is at the end of the process not the beginning. WPATH will never accommodate those who don't intend to live as a member of the sex not assigned at birth (unless you get data confirming that hypothesis). The only solution is to fake it. Show up at the shrink in convincing girl drag. Have a believable story.

I know I'm repeating myself, but the SOC, from Benjamin to WPATH, were designed to insure the best outcomes for those planning to live as women within society. They're not equipped to deal with the minority who are just uncomfortable with their birth-body. I don't have a clue how to resolve that.

There is also an issue of ethically based science. Since RLE has had good outcomes it would be unethical to set up a blind trial of X people in each group and see which ones had the 'best' outcomes.

No matter my personal opinion on RLE, I can't see how the medical community could put themselves in that dilemma.

My own personal opinion not to trample on anyone else's is that really your planning on living as a woman what's the big deal.

Quote from: stephaniec on February 02, 2016, 12:47:13 AM
My own personal opinion not to trample on anyone else's is that really your planning on living as a woman what's the big deal.

Can you define living as a woman please?

Quote from: kira21 ♡♡♡ on February 02, 2016, 01:43:01 AM
Can you define living as a woman please?

well to take a broad view and not to be sexist or anti woman or anything considered demeaning whitch I have absolutely no intention to do. Usually  one approaches living as a woman on the most basic and benign level as dressing as other woman dress which in and of itself leaves a lot of leeway . I mean on the most basic level any clothes whether be jeans or slacks that other woman purchase would suffice to fulfill any requirement as be perceive as dressing as the female as opposed to being dressed as a male even though many women blend clothing so in reality it really doesn't matter how one dresses to fulfill any clothing requirement . As far as other issues such as name change on documents and other legal means of existing within the framework of a specific gender if that's your purpose it seems only common sense if you want to be perceive by others as a specific gender .in which case what's the big deal of being perceive as that specific gender in order for the medical professional that's going to rearrange your genitals in order  for you to be perceived as that gender to try in the least offensive and least demeaning way to feel comfortable in surgically rearranging an organ that obviously plays an important individual and social role in your mental well being.

I'll define living as a woman, when you have to make a choice that says am I a man or a woman , you pick woman.

It doesn't need to be any more complicated than that.

Quote from: Serenation on February 02, 2016, 03:02:24 AM
I'll define living as a woman, when you have to make a choice that says am I a man or a woman , you pick woman.

It doesn't need to be any more complicated than that.

this is true . the reality of living in a society with established laws makes it more complicated when your asking someone else to do something to your body. That person you are asking lives under the same laws and is accountable for his/her actions. If a person chooses to live in  the jungle away from society and decides to performed operations on themselves or finds someone willing to do it well go for it. The question is basically about professional accountability as regards medical procedures and not whether there is some objective criteria of what the inherent nature of man or woman is.

Quote from: Cindy on February 02, 2016, 12:38:10 AM
There is also an issue of ethically based science. Since RLE has had good outcomes it would be unethical to set up a blind trial of X people in each group and see which ones had the 'best' outcomes.

No matter my personal opinion on RLE, I can't see how the medical community could put themselves in that dilemma.

Cindy, don't scientists and doctor do this all the time?

For example, try a non-surgical intervention such as physical therapy for some joint procedure and find out the outcomes are just as good? That surgery is an unnecessary risk and expense?

Given that RLE was not arrived at through any scientific means - it appears to have come off the top of someone's head in the '70s, wouldn't it be unethical NOT to determine whether it is really helpful?

Quote from: stephaniec on February 02, 2016, 12:47:13 AM
My own personal opinion not to trample on anyone else's is that really your planning on living as a woman what's the big deal.

But who, exactly, gets to decide that in order to have female-shaped genitals you must live socially as a female?

Quote from: suzifrommd on February 02, 2016, 05:49:06 AM

Cindy, don't scientists and doctor do this all the time?

For example, try a non-surgical intervention such as physical therapy for some joint procedure and find out the outcomes are just as good? That surgery is an unnecessary risk and expense?

Given that RLE was not arrived at through any scientific means - it appears to have come off the top of someone's head in the '70s, wouldn't it be unethical NOT to determine whether it is really helpful?

The first criteria in any medical trial is 'do no harm'. OK I work in a high risk area, the drugs we give people do harm (chemotherapy) but they are ethically justified as there is no alternative to 'let nature take its course'. Which we also do if the chemo regime' is going to increase morbidity over the expected life span of the patient. For example, I will not give chemo to an elderly client who has co-morbidities as it would reduce the limited life span they have.

We will put patients on clinical trials if there is an expectation that has been previously justified experimentally as having a potential to improve life over the current treatment. The ethical justification we go through for such treatments is detailed, and signed off at many levels.

In a blind study we do not know what we are giving to our clients, the worse treatment is the one that has been shown to give the best results (the existing treatment). As soon as there is any sign that an alternative is giving better or worse outcomes the trial is closed and everyone is put onto the new best treatment or the new treatment cancelled and the clients go back to the best available (which may be the existing treatment).

How can I do this for RLE? We can argue that RLE is unnecessary and that freedom of choice is better, but what proof do we have? We need to present evidence that freedom of choice is a better alternative than RLE.

The only experimental group we have to work with (I think) is Argentina that brought in treatment on demand. This was for both HRT and SRS. But the population in Argentina now have the largest detransition rate. This could be due to many reasons and not just due to treatment on demand, there are socioeconomic factors etc that have to be factored in for example. But how we factor them in to a model is extremely difficult. We are looking at life style, happiness, social acceptance, quality of life. All of which have many variables themselves.

In my clinical trials life is simple (I wish). I have parameters to measure, tumour load, complete or partial remission, time of remission, general physics health (yes hon I've cured you from leukaemia but you now have acute hepatic failure and have a week to live).

How do we do such trials on transgender people?

For a start the cohort is extremely difficult to create. I would need matched groups, with similar socioeconomic environments, socialisation, family and psychiatric support. Similar age groups and statistically meaningful power groups. Which just means my groups need to be large enough to ensure that any changes between the groups are statistically rigorous to mean the difference is due to my treatment (freedom of choice compared to RLE) than any other factor.

Now I cannot allow my clients or their treating medical support team know what group they are in (impossible obviously).

The major comorbidity in the fail group is severe depression and or suicide or self harm. Or detransition with all of the life long effects that carries following surgical intervention.

I ask you; how can I possibly reconcile that as a scientist to the major prerogative of 'do no harm'?

This is a Catch22.

Quote from: Cindy on February 02, 2016, 06:55:22 AM
I ask you; how can I possibly reconcile that as a scientist to the major prerogative of 'do no harm'?

Suppose a hospital performing knee replacements insisted that the patient walk around town wheeling a wheelbarrow for a month before the surgery, and then a standard knee replacement was done. And suppose they're getting excellent results.

Are you saying it would be a violation of "do no harm" to try to figure out whether the wheeling of the wheelbarrow for a month in any way contributes to the excellence of the outcome?

I.e. generations of patients would perform weeks of useless activity just because doctors had "always done it that way" and didn't want to jeopardize success?

Wouldn't the same logic have made it unethical to stop requiring RLE for HRT, which used to be standard, but we now know served little purpose?