Quote from: suzifrommd on March 19, 2016, 07:58:42 AM
The power needs to be taken away from these dangerous people. I shudder when I think of how many trans people may have killed themselves when faced with similar treatment. The only way to make sure that doesn't happen is to make such intervention recommended but not required. A doctor recommends we see a therapist before receiving HRT or surgery, but it is not required. The final decision needs to rest with us.

Maybe there's another way, if you could sue a therapist for denying you the letter and they had to justify it. A truly crazy person probably couldn't win. Or a poor one, but it would likely change the behavior of therapists. Its never going to happen of course.

I think the tradeoff either way is in who gets hurt, as it is with so many things in society. People will get hurt with on demand informed consent, just not me. I don't have much faith in fixing the bad medical professionals.

I'm not sure why its good here, perhaps I just got lucky.

Quote from: Cindy on March 19, 2016, 05:35:55 AM

What you call gate keeping is very often making sure your client understands what is going to happen to them and the potential consequences.

At least in my experience, the informed consent model is founded on ensuring the patient clearly understands the impact of the medical interventions.  I was required to acknowledge the information and advice I was given before being prescribed meds.  And this was fine with me.  But, having explained implications to me carefully and thoroughly, no one stood in my path or required letters from a therapist.

Suzi,
I agree.
Your treatment was utterly wrong and unacceptable.

But that means the system you went through is wrong. It does not mean that a good system is inappropriate.

Accreditation standards are being put in place for the USA by WPATH because the USA system is wrong. These recommendations have largely been rejected by Canada and Australia because what they have in place is already superior.

AnonyMs is a special case and I think they know that (we have met and talked) and I continue to enjoy or Skype talks.
I'm trying to say that a good system works well. A bad system will never work, and if you have been a victim of a bad system you will never agree to any system.

In my case I had totally supportive people who helped me, never doubted me and looked after me before and after surgery.. Since I had such a great experience with loving and caring therapists, of course I am biased. What I went through should be the norm. What you went through is just plain disgusting, wrong and illegal. So of course your bias is against the crap you went through.

In my case I keep in touch with my therapists because I like them, and they like me.

Do I need them? No. Do I respect them? Yes.

Would I recommend them? You bet.

I'm transitioning on the NHS in the UK at the moment, and while I don't object to the idea that patients should be aware of the effects and consequences of HRT, so far I haven't been given any information about that by the NHS - I'm only aware via research that I've done by myself here and elsewhere. If I hadn't, the only information I would have received from the NHS so far is that:

- society looks down on trans people (shocker, i know)
- i might end up being perceived as male like i want to - or I might end up looking like (exact quote) 'an ugly girl with a beard'
- vague implications that major surgery might just be difficult (because I must have been thinking having chunks of flesh removed would be easy)

Admittedly, I'm early on - I've only had the GP meeting to request the referral, and two psychologist meetings. But if it's the gender identity clinc's job to talk to me about HRT and its effects etc, and the psychologist's job to check that I'm emotionally ready and don't have any unrelated issues, why did she only talk to me about how terrible an idea transitioning is/ that I'll never ~pass/ that I'm not as burly and butch as she expected?

I feel like if it wasn't a gatekeeping meeting, and was actually about my mental health, i wouldn't have been asked those questions - about my sexuality or my sex life, or about if i was prepared to become a social pariah. I was asked if I'd done any research of my own, and i said I'd researched online both through the NHS's own website and resources, this forum, and youtube videos of actual trans people talking about their lived experiences. The psych didn't seem to think this was enough - but didn't give me any alternative resources. They didn't even ask what my research had taught me so for all they know i could have an entirely incorrect idea of what HRT does. What if I had done no research at all? How can they assess if I'm ready for changes if they can't be sure that I'm even aware of what these changes are?

I expect that I'll be given better info by the GIC when I eventually get a meeting there, but I don't understand how the two meetings i had with psychology would have told the NHS anything about my mental state or competency as most of what we talked about aside from the scare tactics about how i'm too pretty to pass as male, was me trying to explain the concept of bisexuality and clarifying that I haven't already had a chest reduction, I'm just binding.

To me those meetings didn't feel useful, they felt like they were designed to put me off, or test that i'm willing to put the effort in to push for a referral and that i'm not just transitioning on a whim - and they made me very depressed for weeks. They were not designed to educate me or support me in any way. I wasn't asked if i feel anxious or depressed i was told that i should feel anxious, unsafe and depressed.

Bear in mind that I can't afford to go private, and that this psych was the only one in my area and is working with the GIC that I'll be referred to. I've heard that bridging hormones is sometimes possible on the NHS - meaning that it's possible for my GP to proscribe me HRT but only at their discretion, and most GPs would likely be uncomfortable proscribing without first consulting with psychology or with a GIC first anyway. Part of the problem with gate keeping is that for a lot of us the options are very limited. If the NHS was to turn me away I wouldn't be able to transition for years, if at all.

I also understand that there's a lot of pressure on the NHS but perhaps that could be relieved somewhat by not referring me to a psych for two useless meetings?

I support WPATH and the standards of care however, I feel firmly they are guidelines and not concrete rules. Ultimately, I see being transgender as a medical issue and even though I went to a place that was "informed consent" after a time of Self-medication with occasional medical supervision and I still had to meet with a therapist before treatment would be given, just to ensure that I understood the ramifications of my choices and that I was able to make those choices of sound mind.

I don't mind any of that. I view it as advantageous to the community to keep GID as a Pathalogical condition for the sake of arguing for our rights. It is much easier to win the argument that trans people need medical care for a medical condition than it is to explain to those outside of the TG community that some people elect to get treated without any diagnosis and some don't but, some of us absolutely get our lives cut short by not getting that treatment and it is a life or death matter that it be covered.

Basically one is a much cleaner narrative and if there is one thing I have learned during my transition is that an additive that requires nuance is beyond the general publics understanding.

Mixed emotions on this one. Two individuals I know of. Can't imagine anyone signing a mental health letter for. "If" I worked at a guy store I would never.. repeat never.. sell them a gun or ammo. "If" I worked at the bar or the 7/11.. I would certainly think twice about selling them alcohol. HRT?.. Might be exactly what they need??? Then the 1000's of articulate, informed, sane, sober individuals in this community? In Thailand. If you're tall enough to reach over the pharmacists counter.. cash wadded up in your little hand.. You're gonna walk down the street with hormones. Seems to work.

Quote from: Hikari on March 19, 2016, 01:57:39 PM
I support WPATH and the standards of care however, I feel firmly they are guidelines and not concrete rules.

Well, they ARE guidelines. Recommendations, actually, and it says that very thing in the SOC. People seem to want to regard WPATH SOC as if they are law, and it just ain't so.

In my experience, physicians themselves tend to be more strict with what they require from a trans patient than the SOC recommends. If someone is having a problem getting what they need from a doctor then they ought to know that it's the doctor who has the final say. The first question one should ask the doc is if they use WPATH SOC as a guide to inform their practice. If not, your results may vary.

I changed my mind on this matter in past couple months... Im 110% against any requirements for genital reconstruction, or penectomy or orchiectomy. People who are sane can obviously decide for themselves what choices they make and what works the best for them... and people who are insane, god bless them, I dont mind if they want to have their private parts reconstructed, if they pay for it themself. It doesnt affect me in any way. There are probably some cis guys who for whatever reason start to believe that they are in fact transsexual, and want to have SRS... Let them have it! Its actually funny (in a very twisted way) if you think about it...

Surgeons and psychiatrists should better make sure to protect themselves legally though.

Quote from: mmmmm on June 21, 2016, 10:25:04 PM
I changed my mind on this matter in past couple months... Im 110% against any requirements for genital reconstruction, or penectomy or orchiectomy.

I changed my mind too. There's too much abuse in the current system and not much chance of it getting fixed.

Quote from: mmmmm on June 21, 2016, 10:25:04 PM
People who are sane can obviously decide for themselves what choices they make and what works the best for them... and people who are insane, god bless them, I dont mind if they want to have their private parts reconstructed, if they pay for it themself. It doesnt affect me in any way. There are probably some cis guys who for whatever reason start to believe that they are in fact transsexual, and want to have SRS... Let them have it! Its actually funny (in a very twisted way) if you think about it...

Funny? No. I think its sad, but we are  only human and no matter what rules we come up someone's going to suffer. I side with more freedom, less overall suffering and more good, and to be selfish about it, someone else doing the suffering.

We even had to go through a psych eval for Fertility treatment a while ago... at least that was only one session...

It is a problematic situation, especially on the surgery topic. This is truly major surgery - I do believe everyone willing to go that route has thought about it for quite while and hopefully knows what he is up for. Any kind of surgery comes with lengthy consent forms to sign. So yes, having to add years of therapy still feels like being trans is treated like a mental illness. My hope is that the current ongoing discussion will improve the situation. The current requirements make it especially hard for "non binary leaning m or f" - Having SRS would absolutely help my mental state no matter how much transitioning I am planning to do or not.

I think I have mentioned this before, my preference would be SRS first, then HRT then decide how much I want to be out in public. Or SRS and HRT at the same time.

My insurance follows WPATH (and of course does not pay the "cosmetic" portions). Same applies to all of the potential places for SRS I looked at. Does not make me happy and I hope the thinking evolves. I am actually doing pretty well right now and the only reason for me to see a therapist would be to get insurance to cover meds and surgery. Not a very good reason. I do believe HRT needs to be monitored so yes - medical supervision should be required here. Everything else is just doctors covering their backs and ensuring that another doctor can buy a yacht.

So.. I do believe that informed consent would be the better option.

Quote from: AnonyMs on June 22, 2016, 03:03:08 AM
Funny? No. I think its sad, but we are  only human and no matter what rules we come up someone's going to suffer. I side with more freedom, less overall suffering and more good, and to be selfish about it, someone else doing the suffering.

... in a world where people kill innocent people because they dont share the same sincerely held religious beliefs, and children still die from hunger, I could probably find 10000 things that will be more sad than someone mistakenly thinking they are trans ends up having SRS.

Quote from: mmmmm on June 21, 2016, 10:25:04 PM
I changed my mind on this matter in past couple months... Im 110% against any requirements for genital reconstruction, or penectomy or orchiectomy. People who are sane can obviously decide for themselves what choices they make and what works the best for them... and people who are insane, god bless them, I dont mind if they want to have their private parts reconstructed, if they pay for it themself. It doesnt affect me in any way. There are probably some cis guys who for whatever reason start to believe that they are in fact transsexual, and want to have SRS... Let them have it! Its actually funny (in a very twisted way) if you think about it...

Surgeons and psychiatrists should better make sure to protect themselves legally though.

Yeah, and there are people who think fifty LGBT people gunned down in a nightclub is funny, too. There's a word for  people like that...but we can't use it on the forum.

Quote from: Devlyn Marie on June 22, 2016, 10:53:10 AM
Yeah, and there are people who think fifty LGBT people gunned down in a nightclub is funny, too. There's a word for  people like that...but we can't use it on the forum.

I disagree, "evil" is a perfectly usable word on the forums.

Quote from: Dee Marshall on June 22, 2016, 11:37:32 AM

Quote from: Devlyn Marie on June 22, 2016, 10:53:10 AM
Yeah, and there are people who think fifty LGBT people gunned down in a nightclub is funny, too. There's a word for  people like that...but we can't use it on the forum.

I disagree, "evil" is a perfectly usable word on the forums.

"evil" is a four letter word, young lady! 

Hugs, Devlyn

Snicker! You called me young! A new co worker thought that I was 20 years younger than I am. Being transgender is an awfully expensive (in time, money, and anguish) fountain of youth.

Sent from my SHIELD Tablet using Tapatalk

While I believe that gatekeepers are needed in some capacity, people need to be careful of harming individuals through implementation of rigid and unwaiverable policies. 

Today is my first visit back here in almost four years.  Since my last visit I learned to live and enjoy life.  I learned to put my female self before my trans side, often going weeks or more without ever really thinking about my long past transition.  I was no longer "transitioning," but had, instead evolved to embrace myself as a woman rather than a transgender woman. 

When I put my trans side behind me, all of my legal work was done EXCEPT for the sex marker on my Texas birth certificate.  I was recently informed that it was finally possible to change that, so I took it upon myself complete the legal side of my transition as well.  One key document required to petition the court is a letter from a doctor attesting that I had completed appropriate treatment..."  No problem, right?  WRONG

The doctor I approached for help didn't feel comfortable writing a letter so soon.  I obviously need more therapy to deal with my gender issues.  HOGWASH

I'm now 13 years post op.  I've gone back to school and graduated.  I've worked in multiple occupations "in stealth" without issues.  My family issues were even behind me, and I was finally accepted as a daughter, sister, niece and granddaughter. 

I was able to go weeks without even thinking about gender related issues, but because of rigid gatekeeping practices, I'm pulled out of the "I'm a woman" mentality, and being forcefully made to revert to the repressive "I am, and always will be transgender" mentality.  Unwavering gatekeeping designed to help people cope with transition have caused anxiety and depression.  Happy ==> depressed.  Completed transition ==> restarting the cycle for the sake of "rules and guidelines."   Ugh

Some rules are needed, but they need to be flexible enough to accommodate the needs of each individual.   

Peep's story brings out an important point:
Medical advice should not be biased.

It is already difficult, on many levels. Medical practitioners cant make discomfort go away just by telling you 'oh you dont fit all the boxes on our trans-meter so its better if you stay where you are'. 'Oh and by the way this trans-meter isnt free and you have to pay 300+ per session'

This is B.S. Just let people know all the relevant (unbiased) info and then give them the treatment. Chances of them regretting it are slim, and getting it on a whim are nonexistent.

I think that at a certain point, delays and prevarication under WPATH become de facto gatekeeping. Especially when horrendous waiting lists for hormones and surgery - to which you will *not* be added without therapist approval - are involved. I've spent nearly a year waiting for therapy, getting therapy (that I'm not at all certain that I needed or substantially benefited from) and (finally) sitting on a half year waiting list for HRT. If I could have afforded it and another option were available (and it turns out there was, I just wasn't told about it) I would have gone elsewhere and received faster treatment. I can well understand that medical providers have an ethical responsibility, but dithering and dilly dallying isn't good care either when someone is drowning in gender dysphoria despite having (as I already had by that point) come out of work, come out to family, started to dress as a man full time, begun the legal process of changing their name ... Did I really need therapist approval of my decision or my gender clarified for me in some fashion before being put on the waiting list? No. I don't really think so.

I wonder if they're questioning without coming out and saying directly whether being transgender is a mental illness or just a personal decision. Did anyone else wonder that?

My first therapist I saw about gender dysphoria said he couldn't write any letters because many of the people regret it and commit suicide and he also said some abusive things despite the fact that he was listed to deal with transgender patients which some in my area won't deal with. My current therapist said he had no right to do that and wasn't following the rules. She said the only reason for them to refuse a letter would be if you were psychotic, and he shouldn't just refuse it because he doesn't believe how I said I feel or agree with the decision to start T.

Quote from: suzifrommd on March 19, 2016, 07:58:42 AM
What I call gatekeeping is giving therapists veto power over some aspect of our transition care. When you require a therapist's letter you are doing just that.

Once you do that, it becomes up to each individual therapist to decide what hoops their client must jump through before they write that letter. Here are some hoops I was made to jump through as late as 2012:

* I was asked intrusive questions about my sexual interests, whose answers were shared with my wife.
* Another therapist was given a secret directive from his boss (who had evaluated me as a condition of being seen) that he was to talk me out of transitioning. I had to demand to see my medical record before that directive was shared with me.
* A third therapist refused to write a surgery letter, giving as a reason that I was still living with my wife.

There is no recourse against these therapists. I lodged complaints against the first and the third which went nowhere.

The power needs to be taken away from these dangerous people. I shudder when I think of how many trans people may have killed themselves when faced with similar treatment. The only way to make sure that doesn't happen is to make such intervention recommended but not required. A doctor recommends we see a therapist before receiving HRT or surgery, but it is not required. The final decision needs to rest with us.

The same type of thing happened to me with the first therapist I went to about getting a hormone letter. He used my past mental health issues against me and emotionally abused me. My new therapist said that he's got pending cases against him with our local transgender alliance for abusing his power, and they're sure he's done it, but it's hard to prove or have anything done about it.