So my gender therapist (the only one in the city, of course) requires that patients live full time as the desired gender for 6 mos. to 1 year before he will consider giving hormones. To me, this seems sort of cruel, but he basically has me by the balls (no pun intended).

Although, he did offer to refer me to an endo, who will do the prescribing, so maybe the endo will be more liberal about this?

I really don't want to start buying off the internet or something like that. Even though I won't be taking hormones for a while (i'm just on spiro for now), I would like to know if I have any other options your ppl might know about.

Basically, he wants to know that I'm serious about the whole process and that I'm stable enough to go through with it. But I might be able to budge him or the endo a bit if I keep seeing him, and show him that I can go through with this. I just hate not knowing what he thinks about me, and I don't want to have to act too fake!

Thanks,

Chrissi

It was a year after RLT that i was first prescribed HRT.  And your right its a horrible system that some therapists use, but in terms of options there aren't many.  Therapists can set any rules they want and we can't do anything about that, but hope that your therapist decides 6 months of RLT is long enough for you. 

Most therapists will want to check out general health before prescribing hrt, so that could be why he wants you to see an endo.

Other option would be to change therapist (in a different city if necessary).

hi chrissi.  my experience was much like jenny's.  i was about a year 24/7 before i started hrt.  i could have before, but it was my own reticense that prevented it.  i think the hbsoc, or wpath now, recommends about 6 mo of rle before beginning hrt...i could be wrong, but my point is that it sounds reasonable.  if you are doing spiro and not being monitored then you are, and i state catagorically, making a mistake.  don't stop, but get your hiney in to see an md and do it now.  you must be monitored while doing such powerful drugs!

of course your endo and your therapsist may have different ideas, but they should consult with one another, and with you and ya'll all should arrive at a consensus as to the best course of action.  these kinds of questions don't have yes or no, concrete answers, they are subjective and since it's your body you carry the oenus of making any final decisions...but your decisions have to be within the scope of what your prescriber considers to be within his rational and ethical boundaries.  he cannot prescribe for you something that he feels might do you harm, regardless of your feelings.  Good luck and God bless with...

I always hated the idea of RLE before HRT. Who are they to tell us to risk ourselves just so *they* can make sure we're not doing something we'll regret? I, myself, probably would have said screw it if I had to do RLE first since back then I was sooo self conscious about myself and could have never done it without the changes I had from HRT to help me become more comfortable and more confident in myself and my image. If we feel this is right for us, then nobody else should be able to tell us what to do, or how to do it. There are much, much worse things people can do without having to have a gatekeeper that it seems ridiculous that the trans community still has to put up with this. People can get breast augs, facial surgery, so many other things that have far more impact on someone than HRT does, yet they don't have to go to a therapist and beg for their approval first or go through a ridiculous set of hoops before being allowed to take the necessary steps.

I wish you luck and I hope you can sway him to let you get them earlier.

- Sarah

Wow... Your therapist is a stupid idiot.

Quote from: Kara-Xen on November 06, 2008, 09:20:42 AM
Wow... Your therapist is a stupid idiot.

Agreed. I'd find another one, although I realize that's easier said than done. Also keep in mind that not all doctors or endos require a therapists recommendation. You're perfectly justified in shopping around for one on your own. You may even be able to find a doc/endo who'll recommend a therapist THEY work with.

Everyone has different motives, but I would never have done the RLT before I passed reasonably well via HRT. It was never about "presenting" for me, or being feminine, or any of that. I needed *acceptance* as a female, to blend in, so just walking around in public as obvious male wearing women's clothes would have been pointless for me. That's not a "test," that's cruel, missing-the-point torture, IMHO.

Kate

I was lucky and had HRT prescribed before i started my RLT. Like the others have said your a slave to your therapist or health system but yes i have long been against this system too.

It protects the weak in one respect but also makes victims of others, its not easy to pass for many and society can be an unforgiving place.

Good luck hunny.

haha, how does he expect you to be stable or see if you can live as a woman pre hrt?

in my case id have gone nuts...

who said it....we all have a right to shop around....that's even wise!  but calling someone a "stupid idiot" because they don't see things your way is a little much.

professionals have their own minds and their own attitudes and they have to live with them.  i don't think it's at all right to denigrate someone for doing what they think is right.  you may disagree, but they wouldn't have the right to call you a "stupid idiot" for disagreeing with them.  were i an md i would definitely not perscribe hormones, or any other drugs, to someone i wasn't convinced could be helped by them....that *I* wasn't convinced.....my name would go on that perscription and my ability to sleep at night is what's on the line for me.  were i a therapist i wouldn't refer anyone for hrt until i was convinced it was right for them...my name would go on that letter.  how selfish is that?  you, mr professional, have to practice your profession as I see fit, not you...me!

if you want to prescribe, get yourself and md and license to practice and prescribe away, then you won't have to deal with those "stupid idiots" who have done the leg work to get where they are and feel a personal need to subscribe to accepted ethical practices...not just run the world on their own.

if you want respect, rule number one is...be respectful.  God bless us all with... 

OK. Then he's incredibly "misguided," IMHO.

The RLT is supposed to "test" us living as we intend to live. If someone intends to live without HRT and passing, dressing in women's clothes and dealing with the consequences of that all her life... then a "RLT" trial without hormones makes sense.

But if someone intends to assimilate as an ordinary female, what does going out looking like a male "presenting enfemme" prove? If anything, it'll just scar and injure someone's confidence and psyche, IMHO. My assimilated post-HRT life in no way resembles what life would have been like dressing in women's clothes in public before HRT.

I do agree that a professional has every right to "qualify" a patient before signing his or her name to an HRT recommendation letter. But I believe that "approval" should be based on a patient's total commitment to transition, realistic expectations, emotional stability and a suitable environment and support network being in place. HRT faciliates the RLT, not the other way around, IMHO.I never "went fulltime" or "started my RLT." Instead, both happened as a *consequence* of HRT.

Kate

QuoteWow... Your therapist is a stupid idiot.

Damn right! My previous therapist tried to pull that bull->-bleeped-<- on me. I quit seeing them even through they are like the only therapist in the area. I'd like to take this at my own pace with the aid of hormones. At this moment, I'm doing the self medication route, only because I haven't gotten some ->-bleeped-<-s okay to do hormones.

Quote from: je on November 06, 2008, 11:36:13 AM

QuoteWow... Your therapist is a stupid idiot.

[..] right! My previous therapist tried to pull that [..] on me. I quit seeing them even through they are like the only therapist in the area. I'd like to take this at my own pace with the aid of hormones. At this moment, I'm doing the self medication route, only because I haven't gotten some ->-bleeped-<-s okay to do hormones.

I agree completely that the whole RLT before HRT is wrong and not in most of our best interests.  Its a fact that HRT helps with passing, and this therapists approach does nothing but make transition harder and more painful.

However transition involves medical treatment and so doctors/therapists are really needed.  HRT can be dangerous especially without proper monitoring.  Also surgery is gonna be easier to get if you try to stay within the "system".

I don't think doing things on your own is a better option than seeing unhelpful therapists, IMO

Sometimes the system wont help.

Self medication CAN be bad, but if you see a doctor and ask them to monitor you for safety, most will... they cannot refuse on the most part thanks to the hipocratic oath.

Self medication CAN be safe, i did it for over 9 months.

Sometimes we have to do things ourselves...

Before I ever saw my therapist I was self-medicating.  My therapist was not happy about it, because I was not being monitored, but he understood.   When I saw my doctor for the first time, I also told him.  His reaction was to stop doing that and promptly issued me my script.

I agree find another therapist.  Yours is a moron.  RLT is to get used to dealing with any problems that come with being a woman.  HRT will only help. Not the other way round.

Quote from: Starbuck on November 07, 2008, 07:23:20 AM
...Sometimes the system wont help...
...Sometimes we have to do things ourselves...

Most definitely. But it can be done properly with some effort. I did my first year of RLT and HRT in a small rural town in Nebraska where the doctors and therapists had zero transsexual experience. When I finally found a therapist and a MD who were willing to treat/monitor me I essentially taught them how to do it by flooding them both with the medical information they needed. I have no regrets. They both turned out to be great support systems and helped me get through some tough times.

In regards to whether it is best before or after to take hormones prior to RLT, due to my own experience with HRT I believe that hormones should be given before RLT not to just help them pass but because I believe it can help weed out the people who have doubts or those who are not truly transsexual. IMHO, the initial psychological and physical effects of estrogen and testosterone blockers would be welcomed by the TS and to the person who has doubts or is unsure, scary enough to stop the treatment. (e.g. male thought patterns changed, sexual shutdown, 2nd puberty emotional effects etc.) Come to think of it, face and neck electrolysis is also a good test. 

Dora

well...of course i see things very differently then the majority around here.  since the affects of hrt can be permanent and can become permanent to different people under different time frames, it makes perfect sense to me that one demonstrate their committment to transiton for at least some period of time before beginning the hormones that may end up negatively affecting some for the rest of their lives.  of course that's a "stupid idiot" idea, but as a card carrying "stupid idiot" i'll just hang on to it.

some among us might really benefit from researching some of the history of transsexualism and it's treatment in our country.  there was a period in our history when one of the nation's major medical teaching facilities concurred with the conventional wisdom around here...everybody is exactly what they say they are, even before experiencing what they say they are at all and everybody has a perfect right to make their own choices and the medical community should feel compeled to see to their needs as they self-describe.  the results were desaterous.  literally thousands of non-transsexuals were treated for transsexualism on demand simply because they walked in the door and said they were transsexual.  we learned that treating non-transsexuals for transsexualism was just as ludicris as treating non-cancer patients for cancer.  wouldn't it just be absurd for a surgeon to just start operating on someone because she walked in the door and announced she had breast cancer and was sure that removing her breasts was what she needed?  wouldn't we absolutely demand that doctor at least make some effort to confirm the diagnosis herself before the cutting got going?

it's the same with us.  obsessive transvestites, cross-dressers, autogynephilics and ->-bleeped-<-s walk in therapists doors every day and annouce they are transsexual, demand hrt...and some even surgery.  we don't have a test we can administer physically.  we can't draw some blood, check out a few enzymes and make a diagnosis.  the "t" in rlt isn't a test of the person, it's a test of the diagnosis.  it's the best we have right now...and it isn't stupid just because it isn't perfect.

i hope we can refrain from calling people who don't see things our way names and denegrating them because they are trying to do what's right as they see it.  if we can respect each other enough to communicate we can facilitate a better system, we can tweak and refine the process so that it works better for us all.  giving and taking, listening, observing and especially respecting is, in my opinion, a far better way to expedite a better future for us all then just dismissing out of hand other ideas as stupid, or those who don't agree as morons.

in most cases respect begets respect and disrespect begets...guess what?  disrespect.  i was recently advised that i need to grow up.  being around here i realize just how grown up i really am....and it ain't always all that pretty.  God bless us all with...

I agree that RLE before HRT is just cruel, and scarring.  Not to mention unsafe as not being passable in a place like montana could wind up getting oneself killed.  Thats like open season for ->-bleeped-<- hunters here in montucky.  I was on HRT al least one year before full time and it helped immensely.  I do agree that electrolysis is a much better test of someones resolve instead of RLE preHRT. 

Audrey

According to the Standards Of Care (SOC):

QuoteProfessionals sometimes construe the real-life experience as the real-life test of the ultimate diagnosis. If patients prosper in the preferred gender, they are confirmed as "transsexual," but if they decided against continuing, they "must not have been." This reasoning is a confusion of the forces that enable successful adaptation with the presence of a gender identity disorder. The real-life experience tests the person's resolve, the capacity to function in the preferred gender, and the adequacy of social, economic, and psychological supports. It assists both the patient and the mental health professional in their judgments about how to proceed. Diagnosis, although always open for reconsideration, precedes a recommendation for patients to embark on the real-life experience.

Regarding HRT:

QuoteEligibility Criteria. The administration of hormones is not to be lightly undertaken because of their medical and
social risks. Three criteria exist.
1. Age 18 years;
2. Demonstrable knowledge of what hormones medically can and cannot do and their social benefits and risks;
3. Either:
a. A documented real-life experience of at least three months prior to the administration of hormones; or
b. A period of psychotherapy of a duration specified by the mental health professional after the initial evaluation (usually a minimum of three months).

FWIW...

Kate

Quote from: pennyjane on November 08, 2008, 12:20:00 AM
some among us might really benefit from researching some of the history of transsexualism and it's treatment in our country.  there was a period in our history when one of the nation's major medical teaching facilities concurred with the conventional wisdom around here...everybody is exactly what they say they are, even before experiencing what they say they are at all and everybody has a perfect right to make their own choices and the medical community should feel compeled to see to their needs as they self-describe.  the results were desaterous.  literally thousands of non-transsexuals were treated for transsexualism on demand simply because they walked in the door and said they were transsexual.  we learned that treating non-transsexuals for transsexualism was just as ludicris as treating non-cancer patients for cancer.  wouldn't it just be absurd for a surgeon to just start operating on someone because she walked in the door and announced she had breast cancer and was sure that removing her breasts was what she needed?  wouldn't we absolutely demand that doctor at least make some effort to confirm the diagnosis herself before the cutting got going?

it's the same with us.  obsessive transvestites, cross-dressers, autogynephilics and ->-bleeped-<-s walk in therapists doors every day and annouce they are transsexual, demand hrt...and some even surgery.  we don't have a test we can administer physically.  we can't draw some blood, check out a few enzymes and make a diagnosis.  the "t" in rlt isn't a test of the person, it's a test of the diagnosis.  it's the best we have right now...and it isn't stupid just because it isn't perfect.

With all due respect, comparing those two scenarios throws up a problem:

Taking hormones isn't the same thing as having an operation. If you'd said that immediately performing GRS on an individual as soon as they presented as percieved transsexual was the same as operating on a non-cancer patient presenting with percieved breast cancer then yes, I would agree with you.

However, prescribing hormones to an individual in order that they might feel more confident in themselves and allow subtle changes in order to more closely undergo their real-life experience as who they percieve themselves to be, without quite so much scrutiny is, in my opinion, not detracting from the ability of that person to 'prove' they are who they believe they are. Surely you can show the world more easily that you can live as a woman if you physically look and feel like one.

I thought the idea of real life experience was to ascertain whether you could live your life as your percieved gender, not to see whether you could tolerate abuse and hatred from people by living your life as a transsexual person... which, in effect, is what it seems like to me, since the very things that allow you to live your life as your percieved gender are denied you. How is that real life experience of anything other than proving you want it badly enough, and can tolerate anything... rather than that you are who you say you are? It seems a fundamental difference, and a misconception.

It's like saying:

"Okay, you claim you're a squirrel, but you look like a racoon. What we want you to do is to go out there and interact with all the other animals as a squirrel. Prove to us that you're a squirrel.

But to do that, you have to still look like a racoon. Forget that all the other squirrels are accepted by each other because they look like squirrels, what you have to do is to try and fit into that world as a squirrel, find acceptance among your fellow animals, show us you are a squirrel even though no one will believe you are one since you don't have any squirrel features... because we won't let you. You have to prove it some other way."

It doesn't make sense.

But hey, I could be wrong.

hi lieandra.  i think you read right over some of the things i said.  one, rlt....as it is in the official vanacular...is a test of the diagnosis.  if you are under the impression that hrt will negate all those things you mention you are kidding yourself.  all that will still exist with or without hrt.  hormones are not magic pills, they will only take you so far.  if you can't tolerate living as who you are without hrt, odds are you won't afterwards either.  not always, but it's a strong liklihood. 

two, hrt is prescribing drugs, very powerful drugs.  and they have permanent affects, irreversible affects on different people during different time frames.  the difference between prescribing hormones and doing surgery is a matter of degree.  for either, confirming the diagnosis to the best of the prescriber's ability, is not only ethical, but it is a moral imperitive.

the exact timeframe for rlt before hrt is very subjective.  the frames do vary from therapist to therapist.  there is no absolute consensus so some referring professionals are more cautious then others.  that doesn't make them "stupid idiots", it doesn't mean they are morons or sadistic, cruel trolls out to kill off all transsexuals.  it may just mean the are cautious people dealing with a very inexact science, with some very intricate and complicated symptoms that have a proven history of mimicing one another very closely.

i think most professionals today will readily refer for medications now based simply on the fact that people are self medicating.  it's a trade off.  she may not be comfortable with her diagnosis but the more immediate danger is medicating without management.  this is dangerous for all of us and all of our younger sisters and brothers to come.  it's a very dangerous way of going about getting what you want.

looking outside of oneself, seeing things from another's perspective...looking at the bigger picture can be very helpful.

kate.  i think the cite you made from the hbsoc make perfect sense and in no way seem to me to be unreasonable, stupid, moronic, or cruel.  in fact, it's very kind....just my opinion.

God bless with...