Hey guys, so I'm after a little help. I'd like to explain properly, so this might take a bit, sorry guys XZ

So to start off with I should say I'm under eighteen, but only by a couple of months. I've been wearing a binder for a year now, and been out to my family for just as long. I live in Australia, but in a quite small city, with no specialists in the trans field. I spent four months a while back going to see a psychiatrist at the request of my endocrinologist, so that I can get on T. My mother is behind me all the way, she even came to see the psychiatrist with me the first time so that she could explain how the whole family is behind me and thinks it's the right decision for me to go on T. I mean, she's not all that happy about it, and she feels a little like she's losing a daughter, but that hasn't stopped her from being behind me, and helping me out as much as she can. You can see it in her eyes that she believes me when I tell her I'm trans, and I think that's plain to everyone.

About five months ago I asked her if I could get my name legally changed (because I'm under eighteen I need her and my father's consent) and that same night she printed out the paperwork, filled it out for me and sent it to my father, who also happily signed. So when I went to see my psychiatrist, I already had a male name, and my mother possitively bursting with the will to help me out and make my situation understood.

Several wonderful sessions later, I was getting along swimmingly with my psych lady who was lovely, and told me she had no problem with it, and that the only thing that might stop me was perhaps my endo guy not wanting to start me on T until I'm over eighteen. She told me the worst I was looking at was a couple of months wait until I could start. I finished my last session with her and happily waited the month until I could see my endo guy again and start T. So I go and see him, and he tells me he got a letter from my psychiatrist telling him that she's not at all supportive of me, and that she thinks it's the wrong decision to put someone as young as me on T. She did however say that she supported me getting a breast reduction (I'm very large). And I'll take a moment to say WHAT THE HELL?! She doesn't want me on T, which takes months and is not intrusive, as well as relatively reversible, but she's happy for me to go and have surgery?!

So naturally, with a recomendation like that, my endo guy's hands were tied even though he clearly wanted to help me, and was very upset at the sight of me crying in his office. He said that I could wait out a year living as a guy (it was in her letter) and go back to see her again, or he could refer me to someone in a larger town, with much more experience.

I'd like to make a side note here. What the HELL is with the 'XXX years spent living as a male' bull?! There is no living as a male! There's only living as an ostracised freak, who everyone thinks is a butch lesbian (regardless of if you like guys) who still has to use the female restroom, and have female written on every piece of documentation because there isn't a hope in hell of passing! How in the hell is that supposed to be living as a guy?!

Anyway, moving on. So basically my psychiatrist lied to my face and cost me a fortune (I'm a student and paying for everything transition related myself, with no aid from parents), as well a large chunk of my life I could have been using seeing someone who actually wanted to help. Now I've been told I'll have to go to Sydney to see another endo guy (my local guy said he'd be happy to continue with me so long as he got the go-ahead from someone with more experience) and that guy will probably want me to see his own psychiatrist. Essentially, I'll have to go through the whole process all over again, at a largely inflated cost. I'll have to take a day or two off work every time I have an appointment, and it will cost me twice what it will cost me to do the same in my own town because of the cost of transportation and accomodation each time. Faced with the prospect of having to do the whole thing all over again, I just find everything about me screaming 'NO!'. Not to mention the cost to me will be huge, and I just don't earn that much as a student!

So I recently heard about the whole 'informed consent' thing, and will readily admit I know absolutely nothing about it, no one even told me it existed. I'm three months off eighteen, I'm not depressed suicidal or anything, I have my full family's support and the only reason I would go through more therapy is to get a letter for T. So my question is, please please someone tell me how I can make it happen! I go to see the new guy on December 1st, and unlike my local guy he's supposed to have a lot of experience dealing with trans people. Is he able to do the 'informed consent' thing for me, or is he not qualified? And if he is, how do I get him to do that for me?

Anything anyone has to say on the matter would really be amazing. Please and thank you in advance (and sorry for the long post!)

I really wish I had information on the matter to help you, but my knowledge of procedure even here is sketchy. All I can say is the behavior of your psychiatrist as absolutely unbelievable. Why would she even bother to lie? That's just evil. I'm sorry you had to deal with that crap.

Informed consent is a recent movement ... that you understand what you are taking on and that you agree to it ... very limited places have started using it.

Have you called your counselor?  I would demand a consultation and discuss her letter.  I would have her explain why she sabotaged you and I would file a complaint with the governing board.  It seems like what she did was completely unethical. 

I would ask my endo guy if he would be comfortable enough to proscribe you hormone blockers -- so at least your body doesn't become more female while you wait to untangle the mess

I'm no expert, but I do have some professional cred on this. I have no idea if "informed consent" exists in Australia in your health care system. I live in the States.

As far as I know, informed consent is the basic mode of operation for health care in America in general, where we have private health care and extensive medical malpractice litigation/liability for doctors. The concept means that patients should be entitled to make their own medical choices for treatment, rather than having doctors tell them what to do. Doctors tell you the options, you choose a course of treatment after being informed, and then sign a bunch of documents saying you were warned of the risks.

Basically, to avoid getting sued, doctors ask for informed consent which means you agree that you know the risks of the treatment and you won't sue them no matter what happens in the future to you.

There are several doctors who do not know what the Standards of Care are or they do know what the Standards of Care are and disagree with the gate-keeping role it gives therapists and doctors. Instead, they will prescribe hormones based on informed consent - that you know what the risks are and sign away the right to sue them later on.

Personally, I do not advocate that people go this route, unless the doctor has experience working with trans patients in general or is part of a clinic that does trans health care more generally. A doctor who has limited experience with TS patients AND doesn't follow the SOC is suspect to me.

In your case, I don't know if any doctors in Australia go the informed consent route or if it even exists as a legal/medical treatment concept, since it seems so tied in to the unique nature of American health care law.  I agree with what was written above that you need to identify how the breakdown happened with this doctor (told you she'd do one thing, did something else) and then report her if it seems to be an ethics breach.

Thanks so much for the info guys I don't know if it's practiced here or not, but if it is I'm going to try my best to make it happen.

And yeah, I can't believe that my psych lady did that to me. I mean, I thought they were supposed to tell you their diagnosis? But she told me something completely different, and was all buddy buddy with me the whole way, until my specialist got the letter that to me made no sense. My mother was outraged too, because she came with me she knew I wasn't lying when I said the psych woman gave me the thumbs up and was really possitive.

But now it's kind of destroyed any idea for future psych help for me, that's why I'm after the 'informed consent' thingamy. I understand that there are things they can talk with us about other than the big elephant in the room, and that they can help us out, but I honestly don't think I'll be able to trust another person like that, talking about my life is hard enough already without having to worry if they're going to stab me in the back. And yeah, I'd go back and confront her, but I don't ever even want to see her again. I don't think I could control myself if I saw her...I'd probably yell and scream at her and stuff

Consider writing her a letter - that lets you take your time to work on the wording and make sure it's not too confrontational.

Quote from: MaxAloysius on November 14, 2010, 12:28:46 AM

. I don't think I could control myself if I saw her...I'd probably yell and scream at her and stuff

I dont blame you, i was getting so heated just reading your post! But i def agree with kyril about writing the letter, that is always a good way to go about it. Im sorry you had to deal with all that, I hope things go a lot better for you now.

In my country it is considered good practice that any referrals or medical statements are read out aloud to the patient before it is forwarded to another professional. My advice would be to get a copy of the letter before anything else to be sure that it is actually the psych and not the endo who's been fooling you. If the psych letter is okay then you could take it to another endo.

Take some time reading it and use some days to calm down. Then take contact with the psych again and ask her for an explanation about why she did not just tell you outright what she thought about your situation instead of deceiving you.



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