There is a growing number of health care professionals who are following a relaxed set of standards for this now. In my area in California, the requirements for getting a letter are not fixed. One can get on HRT in a matter of a month or so and not need to see an endo. We have a GP who does it. She spoke to a TS support group last year that many across the US are now doing a more patient specific scheme.  Some are clearly ready sooner and get their letters fast others who are less so will be required to wait. We have many trans people in our area. My therapist estimated 20000 in the tri-county area. I also went to four gender therapists all saw me on a sliding scale or were free paid by the state.

I got had my SRS letter three months after I started seeing my therapist and after three months of full time. Now, it is also true that I was on DIY HRT for seven years and was dressing in androgynous clothes for over a year before and my hair was shoulder blade length so going full time was not much of a stretch. Basically, it was getting a nice women's hair style and carrying a purse. It ended up that I got my SRS letter about the same time as my legal name change.

So things are changing and for the better.

Maggie

My issue with the "Gatekeeper" concept is because we are diagnosed with GID as psychiatric issue with no recommended treatment option listed for this diagnosis in the DSM, we are at the whim of which ever therapist we happen to stumble upon. Hopefully one gets hold of a good one, one familiar with the SOC and the subsequent recommended treatment options that are advised there. Sadly there is nothing in the DSM that tells a Dr. of Psych or any other therapist that this is the "way it works". And it is this that I feel is the primary reason why we are in "limbo" as to correct diagnosis and treatments accompanied by coverage availability through insurance health plans.

I think the "idea" of being seen by a Therapist when dealing with the results of gender issues are wise. This helps one to understand that they actually are not crazy for "believing" themselves to be the opposite gender in which they were pronounced at birth. The only activities a therapist should have in the issue of GID is to make certain the depression that results from years of holding, in private, these thoughts of opposite gender are dealt with to remove the self-harm danger that lurks there. Also, to help them find a way to adjust and cope if transition is the individuals path to be taken.

I'd like to see the system changed to reflect a GID diagnosis in the DSM as a medically necessary condition. So that once the depression is dealt with "successfully", the entire emphasis is then placed in a qualified medical setting to treat the actual medical condition. That way, I think the process would be greatly less complicated and we wouldn't feel as though we are on a merry-go-round where no one will stop the ride to let us off!

The physicians would still be covered for malpractice. It could reduce the overall time frame for making the life altering adjustments. And, we then, could get on with our lives and ultimately be more productive in them!

Sadly though, as Juliekins pointed out, the current system is more about "money" than it is about fixing the problem at hand.


Dawn   

Quote from: Dawn D. on November 12, 2009, 11:56:30 AM
... because we are diagnosed with GID as psychiatric issue with no recommended treatment option listed for this diagnosis in the DSM...

Hate to break the news, but the DSM (Diagnostic and Statistical Manual of Mental Disorders) doesn't have recommended treatment options for anything.

Quote from: Dawn D. on November 12, 2009, 11:56:30 AM
Sadly though, as Juliekins pointed out, the current system is more about "money" than it is about fixing the problem at hand.

Ain't that the truth 

Quote from: jesse on November 12, 2009, 07:45:45 AM
i have yet to meet a transperson who wasnt well educated on whats going on what the effects of hrt is

Then you're lucky. I go to meetings and hear guys say crap like, "I'm starting T next week! What should I expect? When will my voice drop? Will I get acne? Will I get facial hair? Will it start to fall out if I stop taking T after being on it for a while?"

And I'm sitting there, rolling my eyes and thinking, "Homicide really IS the only option."

Quote from: Flan on November 12, 2009, 12:03:07 PM
Hate to break the news, but the DSM (Diagnostic and Statistical Manual of Mental Disorders) doesn't have recommended treatment options for anything.

Yes Flan, I'm aware there are not treatment options for "anything" in the DSM. Which is why I feel this argument should give greater weight to the concept of necessitating a referral to a "qualified medical setting" for the "actual medical condition" since it has been described as such by AMA Res. No. 122, once you've been diagnosed with GID.

Let the Psych. Dr.'s deal with the resultant trauma creating a depressive state of mind, not caused by GID, but by, having to deal with a lifelong state of misunderstanding who and what we are.


Dawn

Quote from: Renate on November 12, 2009, 07:26:38 AM
Don't kid yourself, gatekeeping never ends.
There's always another hoop to jump through.

A world which is an ouroboros of endless and infinite fellatio?

It's not the hoops I mind, it's the cost of the hoops...

Quote from: K8 on November 12, 2009, 09:25:42 AM
I see the gatekeeping as helpful to me as I struggle through this.  This is not like buying a car or picking up a puppy at the shelter.  This is my life.  I want help along the way.  I want some validation that this is, indeed, something I should be doing.

No one is wanting to take away your possibility of seeing a therapist if you want to. Other people just don't want to be forced into it.

I chose to opt out of the therapest option. I went to one session, got my "ya she's ready hrt permission slip(for just in case)", & the thing sits burried at the bottem of some drawer unused/needed(did my homework before chosing my MD). I'm curious as to has/is anyone getting strung along by a therapest?

Quote from: Bellaon7 on November 12, 2009, 05:47:42 PM
I chose to opt out of the therapest option. I went to one session, got my "ya she's ready hrt permission slip(for just in case)", & the thing sits burried at the bottem of some drawer unused/needed(did my homework before chosing my MD). I'm curious as to has/is anyone getting strung along by a therapest?

I was going to be, which is why in a week or so I see my third therapist.

My first two made it clear they wouldn't recommend me for HRT until I had dressed like a female and proven that I was acting like one 24/7. Which since I can't prove that even if I wanted to because I don't know anyone because of my isolation because of my gender issues over the past year. And because it's a completely arbitrary waste of time. I simply stopped going to both of them after a couple sessions.

I'm only going to the third to try and convince them to write a recommendation. I have no idea what I'm going to talk to them about for the minimum 3 months I'm told they will take before recommending me because I've already gone over everything in my life literally hundreds and hundreds of times over and I don't see myself gaining any insight I haven't already gained. (Certainly neither of the first 2 therapists or my own doctor offered any when they asked a question invariably starting with "have you considered ...").

So yeah, I'm pretty fed up with gatekeeper mentality, and I've probably become very biased against therapists thanks to my experiences with them.

Quote from: jesse on November 12, 2009, 07:05:36 AM
wonder if i can become a canadian lol

sure come on over

Would it be in any way conceivably possible to post an ongoing list of useless therapests by name to save as many of us as possible from this truely horrifying fate?

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Post Merge: November 12, 2009, 07:56:47 PM

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wouldnt that be nice bella check a list before wasting hundreds of dollars
jessica

How many gatekepers? none! it's the worst kind of behaviour with people controling our lives is not a help. The U.K NHS system are the worst culprits. But I always thought the U.S was more liberal and had less of a 'gatekeeper' mentality?

Quote from: SaraR on November 12, 2009, 07:03:48 AM
*** loves living in Ontario Canada

I do as well, but had a really hard time finding resources. It seems like it's hard to find information if you are not in a big city.

Quote from: jesse on November 13, 2009, 02:53:31 AM
wouldnt that be nice bella check a list before wasting hundreds of dollars
jessica

Absolutely. I have run into many psychiatrists who have insulted me and haven't been willing to help.

I'm glad I didn't resort to going to CAMH, the woman who helped me setup an appointment with a good GID psychiatrist said that she deals with people who are emotionally damaged from their experiences there. They would have made me jump through even more unnecessary hoops as well.

Quote from: Tristan H. on November 14, 2009, 09:34:40 AM
I do as well, but had a really hard time finding resources. It seems like it's hard to find information if you are not in a big city.
Absolutely. I have run into many psychiatrists who have insulted me and haven't been willing to help.

I'm glad I didn't resort to going to CAMH, the woman who helped me setup an appointment with a good GID psychiatrist said that she deals with people who are emotionally damaged from their experiences there. They would have made me jump through even more unnecessary hoops as well.

From your post Tristan It starting to sound so familiar with the abusive nature of U.K system. I always thought the U.S were much better towards this kind of treatment.

Quote from: Naturally Blonde on November 14, 2009, 09:42:41 AM
From your post Tristan It starting to sound so familiar with the abusive nature of U.K system. I always thought the U.S were much better towards this kind of treatment.

Well I'm from Canada and it varies from Province to Province. Some don't even have free healthcare, as it's not national system.

We are covered for therapy if it's a psychiatrist, and with those it's hit or miss. We aren't covered for hormones or surgery unless it's through CAMH, which has a bad history with the TG community here. I'm hoping that the community here gets fed up enough to make enough complaints so that the government re-evaluates what clinics should be covered by OHIP(Ontario health insurance) in terms of surgery and hormones.

Quote from: Tristan H. on November 14, 2009, 10:03:04 AM
Well I'm from Canada and it varies from Province to Province. Some don't even have free healthcare, as it's not national system.

We are covered for therapy if it's a psychiatrist, and with those it's hit or miss. We aren't covered for hormones or surgery unless it's through CAMH, which has a bad history with the TG community here. I'm hoping that the community here gets fed up enough to make enough complaints so that the government re-evaluates what clinics should be covered by OHIP(Ontario health insurance) in terms of surgery and hormones.

We don't really get free healthcare either. Our condition is loathed by the NHS and they will try their best not to help us. They also have psychiatrists who are only trained in psychiatry (usually males) and not trained in gender issue's or medical matters or how to go about helping TG patients.
I was personally refused HRT by the NHS psyciatrists and had to go private in order to start hormone therapy. Six years down the line the same thing happened again when I tried to get NHS referrals for SRS. Unfortunitely the NHS see it as a lifestyle 'role change' and not a physical 'gender change' which is what I was seeking.

In the end I had to create my own treatment program independently and got referrals quite easily. If you are serious about transition and want to go about it properly and need various surgical proceedure's the NHS is best avoided. I'm starting to think other countries like Canada's health system are also a problem for people suffering with GD.

Well, you have to understand that Canada's healthcare system isn't nation wide, it varies. Some provinces cover TG issues and some don't and it all depends on how. Ontario is one that covers it, however only it's only covered entirely through CAMH. CAMH does have people specialized in GID and gender issues, but they are very backwards thinking. Since all psychiatrists are covered by OHIP, we can easily find coverage for the therapy elsewhere, we just have to find the right psychiatrist which means we don't have to go to private practise necessarily. My issue was that I live in a very small town and found myself being denied by clinics in Toronto for being too far, I eventually did find a group close to me that could refer me to a good psychiatrist that is helpful for GID. I also found out that the original psychiatrists(who weren't specialized in GID) that I went to, were getting complaints from other patients. My town isn't known for being the best medically.

Ontario's system would be much better if we would expand the coverage to more clinics. I cannot speak for other Provinces, though, as I don't know how their systems work.

Quote from: Tristan H. on November 14, 2009, 10:25:58 AM
Well, you have to understand that Canada's healthcare system isn't nation wide, it varies. Some provinces cover TG issues and some don't and it all depends on how. Ontario is one that covers it, however only it's only covered entirely through CAMH. CAMH does have people specialized in GID and gender issues, but they are very backwards thinking. Since all psychiatrists are covered by OHIP, we can easily find coverage for the therapy elsewhere, we just have to find the right psychiatrist which means we don't have to go to private practise necessarily. My issue was that I live in a very small town and found myself being denied by clinics in Toronto for being too far, I eventually did find a group close to me that could refer me to a good psychiatrist that is helpful for GID. I also found out that the original psychiatrists(who weren't specialized in GID) that I went to, were getting complaints from other patients. My town isn't known for being the best medically.

Ontario's system would be much better if we would expand the coverage to more clinics. I cannot speak for other Provinces, though, as I don't know how their systems work.

It sounds very similar to the U.K. We have about 4 gender clinics in the whole country and for me they are of no benefit whatsoever. I wanted a complete physical change which is not covered or endorsed by NHS gender clinics. The only endorse 'role changes' without surgery.

The private sector is much better but patchy and it's not always easy to find the right people for the type of surgery you may need.