After a visit with my therapist yesterday I have been in a pretty bad mood.  It sucked, because I've been feeling better than usual lately.

I get the feeling she hasn't had much experience with trans clients, despite listing herself as a LGBT specialist.  I'm not sure why it came up, but she was under the impression that the SOC suggests 1 year RLE prior to HRT.  I've tried to correct this twice now, reciting the "correct" standards from memory.  This wouldn't inherently seem like a bad thing to me, but even after looking up the correct standards she sounds resistant to offer me a letter for HRT before I have significant RLE.  I haven't even asked for the letter, yet; but that was the impression she's given me the few times the subject of HRT has come up.  I don't know if I can handle doing it that way, and now I'm worried that I'll have to start over with another therapist.  I can kind of understand her point of view, and I'm willing to take it into consideration; but, I wish it didn't seem like she was trying to force it upon me.

Damned gatekeepers.  Just go find somebody else.  Some endocs don't even want a letter.  Some general practitioners will write your Rx.  It ain't brain surgery.

She is working for you, not the other way around.  If an employee doesn't do their job they get the sack.  Sounds like it might be time to find someone more supportive.

Karen.

Cori,
* ...but she was under the impression that the SOC suggests 1 year RLE prior to HRT. *

I know exactly what you must feel like. When I got to this point with my gate-keeper it made me suicidal. I felt being pushed right back into this old "male prison" I'd been in for so long.

When I spoke about my feelings under tears, I was told to stop crying else the process was ended there and then. So much for gate-keepers.

I had to find other ways to get legal HRT and I got it.
It raises the question why something SOC aught be done that way.
What they ask you, is 1 year wall-to-wall 24/7/365 cross-dressing - whilst you busy climbing the walls!
When I asked, if it was not for a doctor to have the best (Hippocratic oath) for the patient in mind --- I got the smug smiling answer that there is no more Hippocratic oath.
So it's pay and take what you get.

It did motivate though to find a GP that understood and I got HRT via this way. Never spoke to the gate-keeper about this, as it was yet another banned subject as was SRS.
Welcome to our world.

And best forgotten it is,
Axelle

Quote from: Axélle on August 12, 2011, 04:32:43 AM
It raises the question why something SOC aught be done that way.
What they ask you, is 1 year wall-to-wall 24/7/365 cross-dressing - whilst you busy climbing the walls!

Actually the SOC requires three months of real-life experience OR a suitable length ("usually a minimum of three months") of psychotherapy instead of real-life experience. So as long as the therapist kind of knows for sure you're serious about it then they can give you hormones without actual RLE... so the SOC isn't too bad! It even specifically says that hormones can be given to those who don't want surgery or RLE. Now if the therapists will actually follow it...

Hon,
thanks for restating the "rules" actually guide lines, - I'm well aware of.
* Now if the therapists will actually follow it... *

For some obscure and undisclosed reason some (physiatrists) just do not follow it and expect you to go a full year RLE --- then suggest SRS, AND ONLY THEN HRT?!?
Even in UK and Germany as I have heard. To me that is SO beyond the pale.

It is my own experience and also that of 2 other t-girl friends of mine having gone (had to go) to the same guy.

Axelle

Quote from: Cori on August 06, 2011, 04:15:42 AM
After a visit with my therapist yesterday I have been in a pretty bad mood.  It sucked, because I've been feeling better than usual lately.

I get the feeling she hasn't had much experience with trans clients, despite listing herself as a LGBT specialist.  I'm not sure why it came up, but she was under the impression that the SOC suggests 1 year RLE prior to HRT.  I've tried to correct this twice now, reciting the "correct" standards from memory.  This wouldn't inherently seem like a bad thing to me, but even after looking up the correct standards she sounds resistant to offer me a letter for HRT before I have significant RLE.  I haven't even asked for the letter, yet; but that was the impression she's given me the few times the subject of HRT has come up.  I don't know if I can handle doing it that way, and now I'm worried that I'll have to start over with another therapist.  I can kind of understand her point of view, and I'm willing to take it into consideration; but, I wish it didn't seem like she was trying to force it upon me.

As I'm sure there are many well qualified GLB therapists out there, I think a good number of them, though well intentioned hang out the full GLBT shingle without realizing that the needs of their T client are vastly different from their GLB clients and being experienced in one does not qualify you for the other.

Yeah, I plan on looking elsewhere if my next appointment doesn't go well.  It's frustrating.  I've spent money on one other therapist already, which never really went anywhere because I couldn't afford his fees.  I'm interested in informed consent facilities, but I'm not sure of any in the Portland area.  Online resources don't seem to list anything, anyway.

I guess I'm just disappointed.  I was beginning to feel comfortable with her.  At least coming out to people is getting easier the more I tell.

Well, that next appointment actually went really well.  No extra waiting will be necessary, so I can start up in a few weeks. 

Quote from: Cori on August 23, 2011, 11:13:59 AM
Well, that next appointment actually went really well.  No extra waiting will be necessary, so I can start up in a few weeks. 

That is good! congrats.

WPATH is an excellent organization with reasonable guidelines, however one would be remiss to consider them rules. And I think that the RLE guidelines for HRT should probably be taken out of the SOC if nothing else due to this clause in the standards of care:

Quote
In selected circumstances, it can be acceptable to provide hormones to patients who have not
fulfilled criterion 3 – for example, to facilitate the provision of monitored therapy using
hormones of known quality, as an alternative to black-market or unsupervised hormone use.

Once a doctor understands the patient wants HRT there is no real way for them to know what lengths they will go to get it, and in most countries it just isn't hard to get black/grey market hormones. Due to this, many clinics have started informed consent HRT, and with that, doing anything more than making sure that the person in question actually desires to transition (what therapy is supposed to do I figure) I feel is against the best interests of all involved.

Okay, rant done.

I'm about to start my first therapy session in October.  I'm having the same doubts about it, and I'm teeming with anxiety.  I've heard that the way gatekeepers go about things varies a lot, but I'm getting the vibe that they're not nearly as understanding or helpful as they should be.  If it doesn't work out, I'm not sure I can find an Endo in my area that would simply prescribe HRT.  If all else fails, I'm seriously considering self medicating.

Hi Amaranth.
Are there any support groups you can contact to find out what others' experiences have been with various therapists?
Karen.

Quote from: Cori on August 16, 2011, 01:32:40 AM
Yeah, I plan on looking elsewhere if my next appointment doesn't go well.  It's frustrating.  I've spent money on one other therapist already, which never really went anywhere because I couldn't afford his fees.  I'm interested in informed consent facilities, but I'm not sure of any in the Portland area.  Online resources don't seem to list anything, anyway.

I guess I'm just disappointed.  I was beginning to feel comfortable with her.  At least coming out to people is getting easier the more I tell.

To be fair Cori you have not revealed how your therapy sessions have progressed or what you have said in these sessions, the number of sessions you've had (Nor are you obligated to) but you have to remember that we are required to be first diagnosed with GID before you can be treated/start receiving treatment.  It really doesn't matter what you think, it's about what she thinks, how she feels as a result of counselling.  If she is a licensed gender therapist then she is obligated to follow ICD-10 to determine the correct diagnosis.  Ya it sucks, hang in there, just don't fall into the trap of shopping for a diagnosis.

Quote from: Amaranth on September 13, 2011, 07:04:32 AM
I'm about to start my first therapy session in October.  I'm having the same doubts about it, and I'm teeming with anxiety.  I've heard that the way gatekeepers go about things varies a lot, but I'm getting the vibe that they're not nearly as understanding or helpful as they should be.  If it doesn't work out, I'm not sure I can find an Endo in my area that would simply prescribe HRT.  If all else fails, I'm seriously considering self medicating.

Don't self medicate - plain and simple.  Transition is not about being on HRT just because you feel you should be. HRT will not make you a man or a woman as the case may be.  They are legally and ethically obligated to determine the correct diagnosis, you don't have to like them but yes, at the same time you should be comfortable with them.  Like it or not ICD-10 clearly outlines what therapists need to determine from the sessions, and they determine this by asking questions and listening to your answers.  Unfortunately this can't be done using x-rays, blood tests, physical examinations.  Just be patient, be open, and above all be honest.  If you are truly TS then you'll be diagnosed as such.

Quote from: Cori on August 06, 2011, 04:15:42 AM
I'm not sure why it came up, but she was under the impression that the SOC suggests 1 year RLE prior to HRT.  I've tried to correct this twice now, reciting the "correct" standards from memory.

I just went through this with my HRT doctor (who prescribed hormones despite this). I saved a copy of the SOC to my phone and plan on showing her at my next appointment.

The 6th edition came out in 2001, so I find it odd that the updated three-pronged criteria isn't as well known as it should be.

Quote from: Cori on August 16, 2011, 01:32:40 AM
Yeah, I plan on looking elsewhere if my next appointment doesn't go well.  It's frustrating.  I've spent money on one other therapist already, which never really went anywhere because I couldn't afford his fees.  I'm interested in informed consent facilities, but I'm not sure of any in the Portland area.  Online resources don't seem to list anything, anyway.

I guess I'm just disappointed.  I was beginning to feel comfortable with her.  At least coming out to people is getting easier the more I tell.

Sometimes one does best going the 'informed consent' route to simply make some inquiries of physicians known to be friendly to the gay community (easily discerned by looking through the gay and lesbian yellow pages).  It worked for me mumble-something years ago, in the days before the internet and I know it still works for some now.  It seems that all too often, resources compiled for transsexuals tend to avoid discussions of anything related to informed consent or even self-medicating...and all too often, the transsexual seeking treatment thinks only to look at those compiled resources instead of looking outside of the box. 

I'll also add that I was never opposed to the notion of self-medicating, especially in this day and age where you can get lab draws on seemingly every other corner for a nominal cost.  The results come back with the same reference ranges as the doc would be looking at which lets the individual know whether they are where they need to be.  Self-medicating in this day and age would be far easier than it was when I had to deal with finding resources and avenues (pre-internet days)...biggest disadvantage is related to cost, especially if one had insurance that would otherwise have covered the costs of prescriptions. 

Justmeinoz,

There is a support group meeting in the same area, around the same time as my first scheduled appointment.  Not sure if it's before or after.  Either way, I've found the therapist I'm going to try my luck with.

Steph,

That makes a lot of sense, but my reasons for wanting to start so quickly don't have anything to do with physical appearance.  I know it'll take a long time for that to change, and they'll never change who I really am, but the only thing that fuels the urge to self medicate is the idea that it will make my body "feel" less masculine.  Even on nothing but AA's, I've heard people say that they feel better about themselves just knowing that no more testosterone is ruining their bodies.

The LGBT therapist I'm seeing apparently gets a hefty amount of T, so I'm confident that they'll be understanding.  My anxiety comes from the fear that I won't be "trans enough" or fit the mold they're looking for to start my treatment without further RLE.  I haven't felt exactly the way I do now since birth.

Quote from: Amaranth on September 13, 2011, 04:58:58 PM
Justmeinoz,

There is a support group meeting in the same area, around the same time as my first scheduled appointment.  Not sure if it's before or after.  Either way, I've found the therapist I'm going to try my luck with.

Steph,

That makes a lot of sense, but my reasons for wanting to start so quickly don't have anything to do with physical appearance.  I know it'll take a long time for that to change, and they'll never change who I really am, but the only thing that fuels the urge to self medicate is the idea that it will make my body "feel" less masculine.  Even on nothing but AA's, I've heard people say that they feel better about themselves just knowing that no more testosterone is ruining their bodies.

Well the jury is out on whether it's the meds or just feeling good that one is finally starting the process that causes one to feel better about oneself.  It's true that reduced testosterone will change your emotional side but how much are you going to take? And while AA can seem pretty innocuous everyone reacts differently to.  All I can do is advice you to be careful.

QuoteThe LGBT therapist I'm seeing apparently gets a hefty amount of T, so I'm confident that they'll be understanding.  My anxiety comes from the fear that I won't be "trans enough" or fit the mold they're looking for to start my treatment without further RLE.  I haven't felt exactly the way I do now since birth.

Then there is always the possibility that you're not trans, ever think of that.  I'm not being mean or anything but it's what therapy is all about.  It can be over a short period of time or it could run into several months.  I was in therapy for over a year, yes it's a long time, and probably too long for most but I felt good in going.  She want to be sure that I was TS, and I wanted to be sure that this thing I had was what I thought it was.  Some approach therapy in an adversarial way, some go in making threats that they will self medicate anyway, etc. I went in wanting to know and I really felt good about going, we did a lot of talking, it can be scary but believe me they don't have a mould because  each of us is different so the way I feel will be different from the way you feel, it has nothing about being trans enough.  A good therapist will allow you to do most of the talking and ask you "Why" all the time to get you talking.  Be honest and you won't have problems.

Quote from: Steph on September 13, 2011, 07:22:14 PM
Well the jury is out on whether it's the meds or just feeling good that one is finally starting the process that causes one to feel better about oneself.  It's true that reduced testosterone will change your emotional side but how much are you going to take? And while AA can seem pretty innocuous everyone reacts differently to.  All I can do is advice you to be careful.

Then there is always the possibility that you're not trans, ever think of that.  I'm not being mean or anything but it's what therapy is all about.  It can be over a short period of time or it could run into several months.  I was in therapy for over a year, yes it's a long time, and probably too long for most but I felt good in going.  She want to be sure that I was TS, and I wanted to be sure that this thing I had was what I thought it was.  Some approach therapy in an adversarial way, some go in making threats that they will self medicate anyway, etc. I went in wanting to know and I really felt good about going, we did a lot of talking, it can be scary but believe me they don't have a mould because  each of us is different so the way I feel will be different from the way you feel, it has nothing about being trans enough.  A good therapist will allow you to do most of the talking and ask you "Why" all the time to get you talking.  Be honest and you won't have problems.

I wish I could support my positive view of HRT, but I really can't.  I don't know what exactly they will do mentally, and I'm happy enough just living the way I do now to be patient, so self-medicating is something I hope I'll never have any experience with.

As far as therapy goes, all I truly know about myself is that I fall somewhere in the "transgender" umbrella term, and I seem to be happier with myself than ever since I started living full time.  I feel TS, but I'm not a doctor.  Your words certainly give me confidence that the "system" is in place to help me rather than deter me, and the last thing I want to do is give false answers to their questions for the sake of fixing the result in my favor.  I was always told cheating hurts no one but yourself. 

Personally, I know the psychological outlines of being diagnosed with TS, and I personally do not fit the criteria because, quite frankly, the criteria fits someone with the IQ of a 13 year old.

For instance, there seems to be a line saying that a person cannot want to be the opposite sex for sociologically beneficial reasons. Well, to be honest, sociology is one of my favorite subjects and I know every percentage and statistic behind the advantages, disadvantages, and perceptions of being male and female, and that's just because I have a high IQ in the subject itself. Because I'm factually smart, I cannot not include certain sociological benefits in my ultimate goal. I'm not a kindergartener who says "I want to be a girl cuz God gave me the wrong body on the outside!" I don't think I was that stupid even when I was 4, I'm simply not a religious person. I don't believe in "souls" or "gods", I believe that I was born with a chemical imbalance in my brain that allowed me to see the benefits and attractions of aligning my body with my personal interests, goals, romance role, aesthetics, and attitude, which, by definition, is being and looking a woman. I care about much, much more than genitalia, because quite frankly, according statistics and science, what genitalia you have is much less important than what face or body shape you have, according to again, various studies and surveys. If my TS disorder is more align with modern science than the TS disorder of someone born in 1942, then that's not my fault.

However, as long as it still qualifies me for hormones, I would not mind at all being diagnosed as TG instead, and I think I do fall under that definition more specifically.