After this was discussed in another thread I felt the responses regarding the length of time (and people's opinions of it) required for HRT was pretty interesting and could use further discussion. The other thread was not specifically about this, it just kind of went in that direction, so I figured starting a new one just for this purpose would be appropriate (also the other thread has been locked so no further discussion will happen there anyhow). If someone has already done this please point me in the direction of the new thread, there are so many different forums on here that I took a peek around but didn't notice anything specifically that was current.

We were basically discussing how there is a 3 month waiting period that you are required to see a therapist during to be able to get your note for HRT and rather or not that was enough time or too much time. Some people seemed to feel it was too long as they've known about their identity for so long that more waiting just seemed to be more painful and sometimes unnecessary. Other's seemed to think an even longer waiting period should be put into place.

My personal opinion is that 3 months is good and appropriate for someone who has already been out and accepted their identity. For people who may not be out I think a longer period (not more than 6 months) should be taken. The reasons for my feelings are based mostly on personal experience of course. My therapist was a very good one, she specializes in trans related therapy to begin with and is very active in our community where I live (in the trans community specifically not the general community) so she has a really good understanding of the issues and challenges we face everyday. She also sees mostly all trans clients with some exceptions so all in all the point is she knows what the heck she is talking about and she is a supportive person, I haven ever had to deal with a therapist who pushes against transitioning or things like that at all, I'm sure that may have changed my view point on the subject.

In my therapy we covered a lot of issues that I don't commonly see come up in these discussions. We talked about not just how I felt, we discussed how it would change my relationship with the people in my life, what kind of support network I had built up. We also talked about one thing I always hear come up but I always hear it in the opposite form. We talked about money. A lot of people bring up the idea that someone may not be able to afford therapy sessions for 3 months or longer, to that I simply say, how the heck are you going to reasonably afford to transition? We discussed how well I'd be able to keep up on my hormones, how I'd be able to pay for them without health insurance and with health insurance. Rather or not my insurance would cover it. How steady my job was, what doctors I'd see and how much that would cost me. Since she had so many other clients she had a reasonable expectation of the financial aspects of transitioning. In the long run this therapy helped me a lot.

I chose to see her for a year before I got my note for hormones, mostly just due the fact that I had other issues to deal with and I had financial issues as well. Honestly she would have written me a note from the very beginning, at the time I started seeing her I had lived openly as male for 7 years and was completely out to everyone in my life. My family was supportive and were ready to deal with any potential changes I chose to make. More than anything the money was the issue that kept me waiting for HRT, my other issues were things like being bipolar and needing medication for that plus therapy for particular traumatic events from my childhood. Those issues didn't resolve that I was trans and had nothing to do with my identity, she accepted that from the beginning and never treated me like I was there for therapy just for the purpose of transitioning. She knew that was a part of why I came but that my being transsexual was not my issue, therapy would just also meet that requirement for me and get it out of the way when the time came to being physical transition.

Anyhow, long story short, my point is that I appreciated the waiting time (if I had not had other issues the 3 months would have been fine with me) because it gave us the chance to talk about the reality of my situation in aspects I had never taken into consideration. The financial discussion helped my choices a lot and in the end were very necessary.

What kind of things did other people deal with in their 3 months of therapy before HRT and how did you feel it helped you as you began transitioning physically? Would you feel differently about the waiting period if you had a therapist like I had who was open and experienced with trans clients?

Therapy ($100 per week or so) is more expensive than T, correct? So if that's all one intended to do, therapy would be a burden.

Can't speak for everyone of course but my father is the only one in my family with a car. He also works 12+ hours a day and cannot afford to take time off of work. For me, therapy is inconvenient. I had to go to my therapist and we basically talked about nothing (not trans issues, just general news and unrelated stuff etc.) because I had to get the required visits first. Two months of talking about basically nothing in therapy does nothing except waste my family's money and time. She already confirmed that she didn't see a reason not to write the letter before that.

If only therapists could decide on a case by case basis. But we can't trust people with that kind of power, can we?

Quote from: Silver on September 11, 2010, 02:43:17 PM
Therapy ($100 per week or so) is more expensive than T, correct? So if that's all one intended to do, therapy would be a burden.

Can't speak for everyone of course but my father is the only one in my family with a car. He also works 12+ hours a day and cannot afford to take time off of work. For me, therapy is inconvenient. I had to go to my therapist and we basically talked about nothing (not trans issues, just general news and unrelated stuff etc.) because I had to get the required visits first. Two months of talking about basically nothing in therapy does nothing except waste my family's money and time. She already confirmed that she didn't see a reason not to write the letter before that.

If only therapists could decide on a case by case basis. But we can't trust people with that kind of power, can we?

Where I am there are lots of therapist who work on sliding scale. The one I saw normally costs about $100 and hour, she saw me once a week for $25, when she wanted me to see her twice a week (due to my other mental health issues) she changed my fee to $15 for each visit. Some people only see their therapist every other week, some only once a month.

There are a lot of other expenses to take into consideration that are different from person to person. It costs me about $500 to get my blood work done, I had to get it done before I started and then once a month for the first 4 months. After that I had to do it every 3 months for a year, then every half a year for I don't even know how long... we are still at that point and I've been on T for 3 years lol.

If I buy my T through a local store it costs me about $120 for a vial that lasts about 4 months, then of course the additional $10 or so for needles and supplies if I do the shots myself. If I can't do the shots myself I can go to my doctor and pay $10 each week to have them do the injection once I buy the T from the pharmacy and bring it in to them.

There are also the fees just to see the doctor to begin with, which also changes from each provider.

Some communities have places that help pay for blood work or do it for a discount, some don't. Some people (like myself) have access to mail order pharmacies and can get their prescription for a lower cost. Some have to pay more for shipping than other people. Some people have to buy it at certain pharmacies for reasons like insurance or convenience.

All in all for me personally I would have spent $300 on therapy by the time I got my note had I only been going or this purpose. I then would have had to spend about $150 on my first endo appointment and then $500 for blood work. I then had to come back after they got back those results on my natural levels of freaking everything under the sun that could possibly be in my body (it feels that way sometimes lol). So there's another $150 and then about $130 for the prescription and supplies. Just to go back a month later and pay another $150 and another $500. I had to pay $1,580 to get through one month on T if you include my initial visit to even get it prescribed. Even had I been paying full price for therapy it would only have come up to $1,200 for 3 months. At my discounted cost I actually paid $300 for that 3 months.

Keep in mind my insurance covered NONE of this. They would not cover my therapy until I was with them for a year because I had other mental health issues and they considered it needed due to pre-existing conditions.

Personally, I think it is difficult to call.....I think it should not be a mandatory ... I think we should allow doctors to make the call based on their medical knowledge.

For example, when I was at the transmedical conference in St. Paul, MN.  I meet some folks who were 50+ years old and they were transitioning....I think they had a full grasp of the consequence.  Plus if your that old I don't think you need permission from someone to alter their body.  I mean seriously there is not a requirement for plastic surgery.

However, when our son told us he was trans ... we insisted on counseling...not b/c we doubted his transition but because he really hadn't experienced life and we wanted someone to ask the hard questions -- how are you going to pay, how is this going to change your life etc.  He is just 21 years old.

Now for me....I am starting to transition... and when I go see my primary care doctor I am going to ask about starting hormones....she has been my doctor for over five years & I see her at least 3-4 times a year sometimes more often.  She knows me pretty well.  She will know me far better than any therapist will get to know me in 3 months.

That being said my wife works with the primary ftm doc in town & she knows our family...she didn't require a letter for our son to start hormones...she knew that he had the support system & the knowledge -- we made him do it.  She would likely give me T too if I asked ... but I would prefer to use my primary.

I think we should trust the profession that are trained and let them decide and not have a minimum.

After waiting over 40 years already, I could have done without the year long wait 

You know you don't have to take hormones and transition they arn't ubiquitous facts, lord knows for me having a correctly functional endocrine system for the first time in my life really allivated alot of the pain I felt about my gender dysphora. If I had large responsibilities in my life kids or I was otherwise extremely unpassable and was enjoying my job that frankly I may loose if I were to transition right then... I might not want to transition any time soon yet under the current system I would also be denied medicines that enhance my quality of life and sanctity of my mind massively.

I think hormone blockers should be available upon request after the first session if there is some degree of confusion about there identity to alleviate some of the anxiety they might be feeling as there isn't really any long term consequences to taking them over the short run and it would provide a useful diagnostic tool to those medical professionals. Sex hormones can be provided later once a clear direction and plan for transition has been established and the ability to cope with the physical changes can be ascertained.

I don't think there should be any specific mandatory waiting period. I think that people, in general, know when they're ready to begin to change physically.

What I do think is important is that the therapist or other professional point of contact for a trans person (1) work with their client to help identify what, if anything, needs to change in their life in order for them to be able to complete a physical transition safely in a stable environment (this definitely involves coming out to important people, name changes, etc and for some people might involve securing stable housing and employment, moving out of a spouse's or parent's home, divorce, or other things), (2) help their client make those changes, and (3) make sure their client has accurate information about what exactly he or she can expect from hormones, how fast the changes may be, and how this could affect existing relationships and other life factors.

This could take some time. But it would be very little time for someone who's already out and socially transitioned, or quite a long time for someone who presents as a secret crossdresser questioning their identity. It's individual. I think the focus should be on what is accomplished in the therapy or counseling, not how many months it takes to accomplish it.

I feel that HRT should be ussed as a diagnostic tool. I KNEW 100% that I was right about my gender on the third day of DIY HRT. If I had not aquired HRT prior to everything else I couldnt have moved on. My therapist works on a slidinscale and I am paying 125$ per session. I feel that is definalty prohibitive I can bearly afford it honestly. HRT is cheep in comparison.
I am not alone in this, there are doctors who advocate HRT as a diagnostic tool.

HRT only took me a very short amount of time to verify what I have known since childhood.

My therapist made me wait 3 months before she would give me an HRT letter, but my family doctor was giving me HRT to stop me from DIY.

If I had to wait the entire 3-4 months I might not have made it. I litteraly kept pushing transition away for so long that it was transition NOW or die by the time I finaly had come out.

Maybe a one size fits all aproach is what is wrong. For some a 2 year wait would seem to be indicated and others seem to need treatment imediatly.

One thing we must remember is that medical professionals have both a moral and legal obligation to care for the mental and physical health of their patients.  To prescribe treatments based on the feelings of the patient would be fool hardy to say the least.  I know that many of us believe we know what's best for us, but lets face it we tend to wear blinders and often the wait time seems intolerable.  The way I approached this is by realizing that transition was just a period of time I needed to endure to ensure being happy with/for the rest of our lives; These things never seem to happen fast enough, but it's a small price to pay when you look at the big picture.

Steph

Quote from: Steph on September 12, 2010, 08:34:57 AMThese things never seem to happen fast enough, but it's a small price to pay when you look at the big picture.

Amen to that.  Although, when I look back on the last 3 months, the amount of progress I've made (despite a non-supportive wife) astounds me.  There are things with seemingly huge delays built in.  For instance, back in July, I went to my family doctor and asked for a referral to the Gender Identity Clinic at CAMH for assessment.  This I saw as a necessary step.  Well, I didn't hear back from them at all for 4 weeks, when I received an intake questionnaire.  At first, those four weeks seemed like forever, but by the time I got the questionnaire, I had largely stopped thinking about "When will I hear from them?", and when it did arrive, it was almost a small shock... "It's HERE!  (gulp)"  I sent it back to them on Sept. 3, and I'm told to expect a 4-week delay till I get an appointment, which will then be at least 3-4 months in the future.  All of which seems like a LONG time to wait just for an assessment appointment, but in the meantime, I can explore hair removal, cross dressing, have talks with my wife, see my therapist, etc.  There's a LOT to do during that time. 

Being 54, at first when came out to myself, I was worried I'd left it all too late.  I feel a lot better about it now.  I know my time will come.  But I do think that perhaps age should be one of the factors in deciding how quickly someone can access hormones, etc.  A 2-year wait for a 54 year old is not the same thing as a 2-year wait for a 25 year old...

Quote from: Cowboi on September 11, 2010, 02:28:12 PM
My personal opinion is that 3 months is good and appropriate for someone who has already been out and accepted their identity. For people who may not be out I think a longer period (not more than 6 months) should be taken.

I agree. It also depends a whole lot on the person, any other pre-existing issues, and where they are now in life (emotionally, economically, etc). I've been living full-time for several years prior to seeing a psychologist, so when I did for the first time, it was not a big life changing experience it is for some. The psychologist was cool, down to earth and basically told me on my second visit she would be writing me my letter as soon as the 3 month limit was over, which I was very happy to hear. No big deal. Some docs it seems, really like to stretch out and prolong the process, even when it is abundantly clear a person has GID.

Off on the deep end.....

So, I have been thinking about this topic a lot recently ...and I have come to the conclusion ... which might be way out there for most of you ... why do we care if someone changes their gender?  Why is there so much wrapped around it all?  We allow people to alter their bodies in all sorts of ways -- tattoos, body piercing, splitting tongues, plastic surgery ... personally, if someone wants to change their body why does someone else have to give approval when in so many other ways we don't monitor or control body modification.

I know some would argue that it's a life changing experience and there is a lot that goes on with it ... but seriously would anyone selectively choose to go through all that if he/she really didn't feel it necessary?  Take medications for the rest of their life?  Save up tons of money for surgies that insurance won't cover.

I don't know .. and I imagine most would disagree with me..but I just feel people should have complete control over their bodies and not be forced to get permission from another person to do it

I am with you on this one Rob.
It is not anyone elses body. Let people do as they will. If they make a bad choice such is the way of life.

My wife made this point once...
If society allows this guy to do what he has with his body without any requirement for phychiatric intervention why do I need to do so to physicaly change my gender.

http://www.google.com/imgres?imgurl=http://samdasilva.files.wordpress.com/2010/03/lizard-man.jpg&imgrefurl=http://samdasilva.wordpress.com/&usg=__eUXcMnPb28hynaas5MXEmz0MwuU=&h=1000&w=682&sz=114&hl=en&start=13&zoom=1&tbnid=N0nPZ5x_qyzOfM:&tbnh=144&tbnw=98&prev=/images%3Fq%3DLizard%2Bman%26um%3D1%26hl%3Den%26sa%3DN%26rls%3Dcom.microsoft:en-us:IE-SearchBox%26biw%3D1076%26bih%3D466%26tbs%3Disch:1&um=1&itbs=1&iact=rc&dur=533&ei=J_CMTL_jNIXSsAPs6629BA&oei=F_CMTIvNMZDmsQPVvZGmBA&esq=5&page=2&ndsp=12&ved=1t:429,r:6,s:13&tx=41&ty=83

QuoteA lot of people bring up the idea that someone may not be able to afford therapy sessions for 3 months or longer, to that I simply say, how the heck are you going to reasonably afford to transition?

On the other hand, let's say a lot of FTMs meet their therapists once a week for three months (paying full price and about the same amount that I paid) before they can get an HRT letter. Then another six months or so before they can get a top surgery letter. This sort of timeline is not at all uncommon. Sometimes it stretches on for longer.

If we go by the amount I paid (or would have paid, for things covered by insurance), the amount that they spend on therapy alone would have covered two evaluative therapy visits, the expensive initial endo visit, a round of blood work, a full year of T, a pre-op exam/blood work, and about half of top surgery.

I can't speak for the women, of course.

Quote from: Rob on September 12, 2010, 09:54:24 AM
Off on the deep end.....

So, I have been thinking about this topic a lot recently ...and I have come to the conclusion ... which might be way out there for most of you ... why do we care if someone changes their gender?  Why is there so much wrapped around it all?  We allow people to alter their bodies in all sorts of ways -- tattoos, body piercing, splitting tongues, plastic surgery ... personally, if someone wants to change their body why does someone else have to give approval when in so many other ways we don't monitor or control body modification.

I agree 100%.

Quote from: Rob on September 12, 2010, 09:54:24 AMI know some would argue that it's a life changing experience and there is a lot that goes on with it ... but seriously would anyone selectively choose to go through all that if he/she really didn't feel it necessary?  Take medications for the rest of their life?  Save up tons of money for surgies that insurance won't cover.

I don't know .. and I imagine most would disagree with me..but I just feel people should have complete control over their bodies and not be forced to get permission from another person to do it

I agree with most all of this, unless there is a pre-existing issue like depression, other mental issues, etc. that would affect a persons decision making abilities.

Quote from: Arch on September 12, 2010, 11:05:25 AM
On the other hand, let's say a lot of FTMs meet their therapists once a week for three months (paying full price and about the same amount that I paid) before they can get an HRT letter. Then another six months or so before they can get a top surgery letter. This sort of timeline is not at all uncommon. Sometimes it stretches on for longer.

If we go by the amount I paid (or would have paid, for things not covered by insurance), the amount that they spend on therapy alone would have covered two evaluative therapy visits, the expensive initial endo visit, a round of blood work, a full year of T, a pre-op exam/blood work, and about half of top surgery.

I can't speak for the women, of course.

Cost. This is another point I think many need to factor in to the whole process. You honestly don't realize how much all this is going to cost until you're in the middle of it. And some therapists as you mention, can unecessarily add to it. Not cool.

Quote from: cynthialee on September 12, 2010, 10:20:27 AM
I am with you on this one Rob.
It is not anyone elses body. Let people do as they will. If they make a bad choice such is the way of life.

We should all be free to make and learn from our own decisions, but there should definitely be a mental health screening process, and a period of time in which the patient is evaluated to ensure that what they experience really is GID.  I know that the label gets passed around when it doesn't belong, but there have been documented cases in the medical literature of patients who were gender dysphoric and thought that they had GID, but ultimately had another issue; I read a paper recently about a schizophrenic woman who wanted to live as a man, whose dysphoria cleared up after a round of antipsychotics.  I'm not saying that every trans identifying patient should try anitpsychotics, or aversion therapy, or whatever before beginning their transition, but there should definitely be an evaluation period to ensure that the patient is in the right mind to begin HRT. 

I didn't do three months of therapy before HRT. I did six. And one could easily argue that it was the equivalent of a year because I was going twice a week. But I knew after about four months (or eight, if you double again) that I needed HRT, and my therapist agreed to write me a letter at that point. Of course, I wasn't planning to actually start HRT for a couple of months. I spent that time grappling with the implications and possible future consequences of my decision.

I needed that time. I knew perfectly well after twelve or thirteen visits that I was not ready for HRT.

I like the informed consent model in theory, but not as much in practice. I honestly think that everyone should see a therapist for at least a couple of sessions. What we're doing is pretty radical, and sometimes we get so close to our problem that we cannot see clearly.

Arch - you needed the time and you knew that. I need some time - and am taking it right now - and I know that. But there's no reason to think that everyone needs the same amount of time or that the time can only start after the first therapy session. Some people like to work things out with the help of a therapist. Others, though, like to work things out in their own heads before talking to strangers about them. And some of us like to work things out entirely in our own heads, but with the occasional discussion with a professional to make sure that what we're coming up with is practical.

I think people in general know what they need, or can figure it out if their mental health point of contact asks the right questions. And if someone already has it worked out, has done their research, grappled with the implications, come out and explained to their loved ones, all the necessary stuff before even talking to a therapist, then why impose an artificial waiting period?

Quote from: kyril on September 13, 2010, 06:34:52 AM
I think people in general know what they need, or can figure it out if their mental health point of contact asks the right questions. And if someone already has it worked out, has done their research, grappled with the implications, come out and explained to their loved ones, all the necessary stuff before even talking to a therapist, then why impose an artificial waiting period?

The waiting period is a guideline only. I think that therapists should be much more aware of this than they are. But I still think that everyone should be evaluated before they start.

I know a therapist here in town who seems way too eager to be everybody's friend...this person would see a guy once and give him the letter on the second visit. While I was active in the community, the therapist did this a number of times. And a few of those guys, in MY opinion, needed real counseling before they bopped off and started HRT. They had some major issues, and from what I hear, they still do. I don't think this therapist served his/her clients well.

So I guess I feel that if you're going to do informed consent, then fire away, damn the torpedoes, take responsibility for not going the therapy route. But if you're going to do therapy, you should have at least a few sessions so that the therapist can be responsible and thorough. I don't feel that three months serves everyone equally well, but I also don't believe that a therapist should just dispense HRT letters like candy.