I'm dressing about 70% of the time but my therapists have said I can start HRT. They agree with me that the transition will be much easier on me the more fem I look. They said the whole idea was for me to develop the self-confidence I need to move forward and become the happy person I have always dreamed of being.

Thanks for the advice all, it just sucks b/c I honestly cannot see another therapist.....there are only two in my province, I see the one I'm talking about, and the other is three hours away....I don't want to do all that traveling just to find out that another shrink will do the same thing as far as RLT goes. I live in a relatively conservative area and I think that I'm screwed either way.

I don't know my shrink very well, maybe he will be willing to budge a little if I show him i'm ready, and an endo may be a bit more liberal. I'm pretty sure I need to come to a session dressed as a woman in order to gain his "OK," but I'm still not sure. I'm scared that if I argue with him he'll become even stricter.
For now, I think staying on the tblockers, changing my name, and getting a few surgeries on my face *could* do the trick, as these are my next steps.

Chrissi

If you are looking to just get as little therapy as needed to get the letters (as probably most of us do) then I think there are also over-the-phone therapists available, although I don't know what qualifications they have and if they'd be able to write the letters. I don't think you should be afraid of your therapist. This road is yours, and yours alone, and we shouldn't have to be afraid of making the wrong step for fear of retaliation by the person who is meant to be guiding us and helping us through this journey. I think you might want to have a talk with this therapist and lay it all on the table on what your timetable is, what steps you want to take, and what result you want.

Also, an endo may not even require the letter, so you may want to think about just going to one and seeing if they'll prescribe without a letter. Also, if you tell the endo you're self-medicating they may also be more inclined to prescribe. A little white lie never heart anyone.

I'm a little late to this thread, but I did want to mention something no one else has pointed out yet. The "live one year as a woman before HRT" thing is one of the original Benjamin Standards of Care guidelines. That goes back to 1979 and has long since been revised based on the actual experience of patients and therapists accumulated over many years.

I would certainly bring a copy of the most recent standards of care to any therapist dropping back to this and ask him or her to explain why they choose to deviate so far from the consensus standards of care governing transsexual therapy. The most recent (as of 2001)  WPATH SOC guideline governing hormone therapy states:

Quote1. 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).

For many, many reasons stated above by others the "one year RLT" standard has been long since revised. I would simply add that a strong previous bias in transsexual therapy tended to filter out all but the most naturally effeminate and passable males from qualifying for HRT or SRS by design. Others have since noted that this is not an appropriate criterion for gauging the seriousness of ones' transsexualism, and the updated standard reflects this.

I wouldn't trust a therapist who still relied on an old version of the SOC (at least one who couldn't give a very compelling reason) any more than I'd go to a medical doctor who still prescribed leeches to treat fevers.

What Dana said.




Dawn

Thanks for bringing that up Dana, I will have to show that to my shrink!! at any rate, as an MtF, don't we usually just take birth control as our estrogen source anyways?? doctors seem to hand birth control out like candy nowadays...

for example...my best friend has 19 yr old twin sisters who are the biggest social loafers on the planet...they are beautiful, but they dont work, dont go to school (haven't finished high school) and all they do is sleep, play video games, and run around with boys.....and THEY BOTH got birth control!!!

so, can't I just get some from my family doctor or have a friend get it for me, since a good portion of my female friends are on it?? Thanks

Chrissi

Im no expert on this but I think from what ive heard. In the past birth control pills contained alot of actual estrogen enough to physicaly affect the development of a male body. However they changed birth control formulas to use alot less estrogen and rely on other chemicals so that the current birth control drugs contain minute amounts of estrogen if any real.

Birth-control pills contain artificial estrogens and progestins that, while quite powerful, are very bad culprits when it comes to causing cancer, clots and the like. Some doctors still prescribe them, as do they conjugated estrogens, but neither are good. You need to take meds that contain either 17beta-estradiol or estradiol valerate. Those are the most bio-identical to human female hormones and thus the safest.

Do your research folks, please! Half the time the endo's and therapists out there are not up to speed. You have to educate yourself so you can protect yourself, even if not self-medicating.

~Simone.

Birth control pills are one of the more dangerous sources of HRT.  For starters the oestrogen is often ethinyloestradiol, which is generally regarded as having far higher risks than other types of oestrogen.  Also most pills contain progesterone as well, and there can be problems with the ratio between oestrogen and progesterone - if you're after the right oestrogen dosage, you run the risk of going way over on progesterone.

Also amongst women using the pill for birth control, horrific life-threatening side-effects are not that rare.  Largely down to the fact that they use cheaper synthetic hormones as opposed to bio-identical hormones.

If anybody was thinking of self-medicating (which i would never advocate) then birth control pills are about the worst way you could possibly go about it.

I see, thanks for the heads up everyone! I'll just cross my fingers in the meantime!

Actually, I have something else to ask....since birth control isn't really "the thing" anymore, what DO mtfs use?? Call me a nOOb, but do they give you medication that is specifically mtfs (prolly wishful thinking, i know)

I know you can inject it, but isn't it (whatever it is) available as pills too?? i'm very needle-phobic!!

Quote from: Icephoenyx on December 07, 2008, 10:55:16 PM
Actually, I have something else to ask....since birth control isn't really "the thing" anymore, what DO mtfs use?? Call me a nOOb, but do they give you medication that is specifically mtfs (prolly wishful thinking, i know)

I know you can inject it, but isn't it (whatever it is) available as pills too?? i'm very needle-phobic!!

It's something you should discuss in detail with an endocrinologist, but generally we get androgen blockers along with the same kind of estrogen given to women on HRT post-menopause.

~Simone.

Pills, transdermal patches, injections all of which are the same forms of estrogen used by post menopausal women also a T blocker such as spiro or andro and a DHT blocker that is the same thing men take for enlarged prostates like proscar or avodart

well i'm already on spiro so that's taken care of!!

For a different outlook:
I felt I owed it to myself to go full time before I tried to get on any kind of HRT.
My take on the situation was that if I could handle living 24/7 without the hormones, then everything after that would be cake (and it was, in comparison).
I guess I was proving to myself (and everyone else) that I was tough enough to do this, no matter what obstacles were in my way.

It was also amusing telling the Endo on the first consultation that I'd already been living as a woman for a several months. He had absolutely no excuse to turn me away. 

I certainly don't see other people who did HRT first as being weak, or 'not tough'.
Nor do I think one way is right and the other way is wrong.
Do whatever you feel is right for you (and what you can get away with, under the constraints of the system).

Thats a good way of looking at it Vex, thanks!

Interesting Vex, not everyone can do that though,

The point has been raised before that you are not living as a woman if you are being clocked 24/7... so is it really a test of anything beside 'how tough' you are? how 'determined' not if you can live as a woman or not? Imo, for many therapists its literally a 'do you want me to let you transition bad enough to humiliate yourself daily? For some, great, go do it, but a lot cant, and thats where the problem lies.

HRT isnt part of the assesment process, or atleast shouldnt be, by then, the therapist and paitent should have a good idea if they need to transition or not, and if they do need to... then theres no need to test...

I cannot agree with RLE before any kind of HRT. I think it would be cruel and cause more damage than we already have to deal with. Some of us just cannot pass without the aid of some kind of HRT; it is a serious error in judgement on the part of the therapist to require that. As a TS, I have come to the realization that I need all the available help there is and am not ashamed to say that I could not pass well with just clothes and makeup.
Isn't it enough that we have so many issues to deal with already without adding another and even more difficult task?
If you can get another therapist do that. Or at least find a way to allow yourself to transition slowly, carefully, and thoughtfully. Going out full time before any HRT is none of those things.
Please be careful and remember that you are important and do not deserve to suffer at teh hands of a professional as well as society.

Well, I've been told I should be ok, and since I only see the guy like twice a year, if that, I don't really know if his policies changed, and the endo may have different views. I guess the next step would be to get referred to the endo and play it out from there. I just hope I can get the hormones when I need them.

Basically, he told me that once you go on hormones, there are some irreversible changes that happen, such as breast development (only can be helped with more surgery, he says). Thats sounds like a bunch of BS to me, but I wouldn't know.

At the tender age of 20, I have come out to my mom, taken spiro for 2 years now, had about 10 sessions of laser and 10 hours of electro, I think that should say enough, but he's the boss!

Chrissi

Quote from: Patriciaz on December 11, 2008, 02:15:59 PM
I cannot agree with RLE before any kind of HRT. I think it would be cruel and cause more damage than we already have to deal with. Some of us just cannot pass without the aid of some kind of HRT; it is a serious error in judgement on the part of the therapist to require that. As a TS, I have come to the realization that I need all the available help there is and am not ashamed to say that I could not pass well with just clothes and makeup.
Isn't it enough that we have so many issues to deal with already without adding another and even more difficult task?

HRT can only do so much; some fat accumulation on the face to soften it, breasts and some lower curvature.
I hate to be harsh, but if someone has a strong, manly face with a square jaw, protruding brows and a bony forehead; then all the HRT in the world won't help. FFS is the only option.
Should they be denied HRT until they have had FFS?

QuoteIf you can get another therapist do that. Or at least find a way to allow yourself to transition slowly, carefully, and thoughtfully. Going out full time before any HRT is none of those things.

What an utter load of inflammatory bollocks.
As people have said over and over, there is no 'right' or 'wrong' way to transition!
Sure, you feel that you can't go full time without HRT - that doesn't mean it is a bad (or 'unthoughtful' or 'careless') for someone else to go full time without it.
I put years of 'thought' and 'care' into my decisions, thankyouverymuch.

IMO, some people get so hung up on passing that they forget that they are doing this for internal reasons, not external ones.