Quote from: Annah on April 11, 2012, 06:08:15 PM
Some people assume that if you do not mind the gateway process then you're a tool and you cannot effectively manage how a therapist treats you. In my opinion, that's just an unproductive stereotype that does utterly nothing but divide people. When people call those who enjoyed their therapy experience as cheerleaders, you can only shake your head and feel sorry for them for being so narrow minded.

Can't argue with that.

Most therapists are helpful. Most Drs only have our best interests and some issue are too complicated for the layman.

I object because I need to seek effective permission, (dress it up any way you wish, it is what it is), to do manage my own body.

There are, of course, many people with all sorts of positive experiences. That's super. But with respect, these are isolated cases, even if there were in the majority.

Most people are expected to go through real life experience. Fine. But I don't need real life experience. I live it.

Most people are faced with an all or nothing. Fine, but I don't want/need all or nothing.

I need control over my own body. If I choose to seek therapy or anything else, that will be my choice.

It is ONE very, VERY touchy subject, - at least for me.

On the one hand I have seen folks "rubber-stamped" and NOT for the better of them and their situation, and on the other end of the scale was my own VERY disturbing process.
To the point that if you don't pass the "gate" who cares if you committed suicide!
You just then 'had it coming to you' - were to 'weak' an individual to transition...
No more "what's best for the patient..." show me the money - the name of the game.
Crying during "therapy" was considered just such a display of weakness, not dressed according to -therapist's- personal taste, no good! Not being involved with a male sexually, not good, don't pass.
Just sick and abhorrent!

So, in the end it seems "everyone to his/her own..." there are good, and pretty well not so good therapists... some truly do not deserve their title.

If you have only ONE just such an individual as the ONLY "gatekeeper" for the whole country (SA) then it does get VERY, VERY painful and most upsetting in deed.

If one has a choice... well, then call yourself lucky.

Axélle

First the differences between NHS and everything else, everywhere else are not valid, no one else has a system quite like NHS (thank god).  And at that, nothing could be further from the NHS model (be it good or bad) than the US system.  So it's absurd to compare them.


Ridiculous yammering is ridiculous.
Oh, you must be new here.

But, trans people... we are assumed to have mental problems?
So long as it's in the DSM, so long will you really have 'mental problems' according to the Big Book of Mental Problems.  Drop it, and so long insurance funding.

What would transitioning look like if GID were removed from the DSM?
Incredibly expensive for individuals, beyond the range of many who now get it. 

Other people have just as drastic surgery to look VERY different than they do. How is that ANY different?
Normal people would cry bloody murder
First, RLT and HRT are things that can be backed out of, surgery, not so much. 

Second, because of this, and because HRT in many places is not subject to gate-keeping it because it's offered on an informed consent basis (at a public health facility) and since it's you making the diagnosis, and you taking the medicine it leaves very little room for blaming (suing) anyone else.  SRS/FFS on the other hand do involve others, high-payed and highly trained specialists.  Those people CAN be - and are - sued by others.  To protect themselves, their investment in themselves, their practice upon which both their family and their patients depend they require a huge measure of cover your ass.

To that degree not only SRS but increasingly many more plastic surgery procedures (and plastic surgeons) are requiring psych evalus for their patients.  (This was common up to the 1950s, it's just making a resurgence.)  Google it and you'll find almost 3 million hits for the topic of psych evalus for plastic surgery.

In 2009 alone, nearly 10,000,000 individuals sought cosmetic procedures in the U.S. alone (Sclafani, 2010). With this growing interest and number of people seeking cosmetic procedures, it has also become important to evaluate the patient's motives and understand what they think plastic surgery can do for them. Unrealistic expectations or impure motives can lead to problems for both the individual undergoing the procedure, as well as the doctors involved in performing the surgery. It is for this very purpose that many individuals are now being referred for psychological evaluations before cosmetic procedures are agreed upon. And in cases when patients may not need formal evaluations, cosmetic surgeons are being trained to be more aware of what to look for in applicants for cosmetic surgery.
http://voices.yahoo.com/why-psychological-evaluations-necessary-8276069.html


You think you are being singled out and picked on, when you're not.  It part of a general trend.

Quote from: tekla on April 13, 2012, 10:31:49 AM
First the differences between NHS and everything else, everywhere else are not valid, no one else has a system quite like NHS (thank god).  And at that, nothing could be further from the NHS model (be it good or bad) than the US system.  So it's absurd to compare them.

Many of us in the U.K have no choice but to go through the NHS system, so it is valid to those of us who live in the U.K.

The topic is about 'gatekeeping' which applies to all people and all countries not just the USA. 

I'm just saying that any comparison between the two systems is going to end up being disingenuous.  I'm not even sure the word 'gatekeeping' is used for the same reasons, in the US it's primarily to guard against lawsuits, in the UK it's meant to keep the general costs down.

Quote from: tekla on April 13, 2012, 11:19:24 AM
I'm just saying that any comparison between the two systems is going to end up being disingenuous.  I'm not even sure the word 'gatekeeping' is used for the same reasons, in the US it's primarily to guard against lawsuits, in the UK it's meant to keep the general costs down.

'Gate keeping' over here is meant as the analysis and diagnosis of gender dysphoria although there have been several cases over here within the NHS where the 'Gatekeeping' has not worked and those recommended for surgery show regret and return to their previous gender role after surgery.

Our private system is probably more like yours in the USA. There was a high profile case of a wealthy transsexual who transitioned privately and then decided after surgery that she wanted to sue the psychiatrist for recommending her for surgery as she wanted to revert back to being a man. 

I guess I chose my therapist well, she wasn't a fan of what people call gatekeeping and it was basically up to me to say whether I was this or that or whatever. She felt she was there to guide me and help me work out any bumpy spots. I probably dealt with her more with grief counseling at the time because my grandmother passed and my dad was terminally ill. I got the hrt letter within a couple sessions and the surgery letter was available within 8 months or so, even though I haven't had need of it yet due to being generally poor.

Quote from: tekla on April 13, 2012, 10:31:49 AM
You think you are being singled out and picked on, when you're not.  It part of a general trend.

I agree with a lot of your post. I can see there needs to be some sort of eval before FFS/GRS but I'm not in agreement that a psych eval is what is needed.

HRT: informed consent should be all that's needed. The meds just aren't that expensive either for most people to just buy them. If someone needs insurance to pay for them or insurance won't pay for the doctor visits or the blood tests, then those people can go for a psych eval for the GID disorder diagnosis.

Any major FFS: a time period of HRT (if nothing else to make sure of what is really needed). I don't think things like an obviously ugly nose etc should require anything. I also think part of a cosmetic surgery training should be in evaluating the patient. I know my FFS doc asked some questions about my goals and what I expected. About why I thought this would improve my life etc. He was aware I was living full time and I was referred to him from my GP for this work. He suggested a lot of things but put zero pressure on me to do more than I wanted. I wonder if all FFS are this low key or are they doing a hard upsell for the "full boat" knowing how fragile most TG patients self image is?

GRS, RLE to make sure the person is happy living in that gender role. If someone is living full time for 6 months to a year, I think that proves they want to live this way.

As far as the DSM and diagnosis with GID, if someone needs this for insurance, then add that requirement based ONLY on the insurance companies requirement. Let the insurance company pay for this too. I'm self pay, as I can't afford an insurance plan in the US that would cover this, so all of this insurance won't cover it stuff doesn't apply to me. *But* I am still required to be diagnosed with a mental disorder and pay for it out of my own pocket before I can proceed with even HRT..

I see this like if your car is in a wreck. If you have insurance you might be required to get 3 estimates of the repair cost before the insurance company will approve it. If you are paying for it yourself, you just go get the car fixed if you work out a deal with the shop. And many times at a lower rate than if they were having to deal with the insurance company.  If someone has to do extra stuff because they are dealing with insurance, people who are not insured shouldn't be subjected to the same hoop jump. Doesn't that make sense?

I have a feeling if the insurance companies figure out this psych eval they require is just costing them more money, that requirement would disappear.

Quote from: Jaime on April 13, 2012, 12:24:16 PM
I guess I chose my therapist well,

I'm sure my therapist would be great for someone who was just coming to terms with being trans. I was way past the point of needing therapist help figuring this stuff out. I don't think a different therapist would have made any difference in my case. It's not that my therapist was a bad therapist, it's that I didn't need one at all to start with. It would be like going to a knee surgeon when there is nothing wrong with my knee, just to make sure...

Quote from: Miki on April 13, 2012, 12:57:04 AM
You don't have any concerns at all that shifting to a purely medical condition would codify insurance/provider standards of care in unfavorable or more discriminatory ways? 

The medical industry is still profit based, and non-standard services and treatments tend to either become genericized as afterthoughts, thereby degrading the level of care,  or made inaccessible by higher pricing structures that categorize them as elective choices, not required treatments.

Would a purely medical diagnosis still make that critical distinction between need and want?  Choice and necessity?

I feel this is where the insurance companies and their requirements might add extra hoops that people who want this covered would have to jump through. It's not unheard of in other cases to get a special diagnosis or refferal before something is covered. If the insurance company requires a psych eval for further procedures, the patient then has to decide if they want to go through all of that or just pay for it themselves. Given how profit oriented insurance companies are, I wonder how long adding these extra cost services would remain a requirement?

As far as the DSM, I have no real problem leaving it in there if it's needed by some people. What I have a problem with is: being required to being diagnosed with a mental disorder before I can get physical treatment, when I am the one having to pay for it.

BTW "elective treatments" are usually FAR less expensive than required ones. Things like cosmetic surgery are given special low rates at a hospital over something like knee surgery. I've had both and a procedure that was aprox same time on the table was 3X more expensive (hospital fees) when it wasn't an elective procedure, even though both times I was self pay.

I have a feeling if the insurance companies figure out this psych eval they require is just costing them more money, that requirement would disappear.

I think most of this is being driven by malpractice insurance carriers.

When I came out to my father... he thought I was just confused / crazy. He dismissed my feelings and figured I was just mentally unstable... said I should go see a therapist.

It is kind of depressing people who support mandatory therapists agree with him... because that is exactly what you are saying.

Under this system... people having a first reaction of "wow, you are likely bat crazy" when you try to tell them you are trans is COMPELTELY justified. Coming out to parents and friends before starting down the road? Well, you better not... they will just say you likely need mental help.

I actually still don't have a therapists letter (even after 13 months on hormones)... so.. I guess everyone should worry about if I'm mentally stable still. You know, because having trans feelings means there is probably something wrong with you?

My brothers and sisters don't have therapist letters proving they are sane either... but, they are cis, so I guess they don't need one?

If I were a normal person learning about transgendered people, I wouldn't trust them (at least not until they had a therapist letter they could show me, maybe 2 or 3 just to be safe). I mean, the trans community itself believes it is pretty likely you are nuts if you are trans!!

When we come out as trans, our status goes from "normal person" to "probably crazy person"... then we need to see a therapist for months and get them to re-grant us "normal person-kind of" status?

I am kind of shocked so many people here believe that having transgendered feelings justifies being thought of as a nut .

If I wanted to work out, get huge muscles, reshape my body to be more manly, get surgery to make myself look more masculine (muscle implants, facial surgery, whatever)... that would be normal, I would just be a guy wanting to be a manly guy. But, if I feel like I would rather have more feminine attributes? That means something is probably wrong with my brain... I need to get checked out first....

Afterall...men should be men right? They should have sex with women and be big and strong. Anything different is a mental defect?


Cool....

It's just that 'transgender' alone is not a monolith - it's a spectrum with many points on it, and many people in here have found that we don't have to go all the way to the end to find satisfaction or happiness.  So perhaps, particulary for the younger people, it makes sense to know they have gone through all the options before settling on the most drastic ones first.

Anyone who has been around these boards for a while has seen evidence of:
- people with other problems that could interfere with transition, or mask it, or enhance it
- people who seem to be making decisions without the full range of options before them
- lots, and lots, and lots of people with unrealistic expectations

to a degree, therapy helps with many of those things.

Granted these standards (like most standards) are pitched to the lowest common denominator, but enough lawsuits could stop any and all of these procedures, so some caution might be prudent.

Quote from: Rabbit on April 13, 2012, 03:59:55 PM
When I came out to my father... he thought I was just confused / crazy. He dismissed my feelings and figured I was just mentally unstable... said I should go see a therapist.

It is kind of depressing people who support mandatory therapists agree with him... because that is exactly what you are saying.

Under this system... people having a first reaction of "wow, you are likely bat crazy" when you try to tell them you are trans is COMPELTELY justified. Coming out to parents and friends before starting down the road? Well, you better not... they will just say you likely need mental help.

I actually still don't have a therapists letter (even after 13 months on hormones)... so.. I guess everyone should worry about if I'm mentally stable still. You know, because having trans feelings means there is probably something wrong with you?

My brothers and sisters don't have therapist letters proving they are sane either... but, they are cis, so I guess they don't need one?

If I were a normal person learning about transgendered people, I wouldn't trust them (at least not until they had a therapist letter they could show me, maybe 2 or 3 just to be safe). I mean, the trans community itself believes it is pretty likely you are nuts if you are trans!!

When we come out as trans, our status goes from "normal person" to "probably crazy person"... then we need to see a therapist for months and get them to re-grant us "normal person-kind of" status?

I am kind of shocked so many people here believe that having transgendered feelings justifies being thought of as a nut .

If I wanted to work out, get huge muscles, reshape my body to be more manly, get surgery to make myself look more masculine (muscle implants, facial surgery, whatever)... that would be normal, I would just be a guy wanting to be a manly guy. But, if I feel like I would rather have more feminine attributes? That means something is probably wrong with my brain... I need to get checked out first....

Afterall...men should be men right? They should have sex with women and be big and strong. Anything different is a mental defect?


Cool....

There's a difference between "Let's rule out other things that could be a contributing factor, before undergoing major, irrevocable life-changing surgery, to make sure it's really what you want and something which will allow you to live your life to the fullest." And "omg you're madder than a box of frogs, wtf is wrong with you??"

I don't think that anyone here is advocating the use of a system which bases its whole ethos on the latter. I can see why you feel the way you do based on your own past experiences, but reading through the replies here, I don't see anything of that nature being supported at all.

Sanity or insanity isn't in question, merely the best approach to allow a person to be who they want to be.

Everyone's experience is clearly very different - but my experience of the "gatekeepers" so far has been of people who see their role as trying to get the gates open for me, not trying to close them.

Quote from: Padma on April 13, 2012, 04:24:01 PM
Everyone's experience is clearly very different - but my experience of the "gatekeepers" so far has been of people who see their role as trying to get the gates open for me, not trying to close them.

Me too, actually.

Quote from: Sephirah on April 13, 2012, 04:11:23 PM
"Let's rule out other things that could be a contributing factor, before undergoing major, irrevocable life-changing surgery, to make sure it's really what you want and something which will allow you to live your life to the fullest."

Why isn't it required of normal people undergoing "major, irrevocable life-changing surgery" and choices?


Answer:

Because a normal person is assumed to be a free rational adult capable of deciding what to do with their own bodies...... and we, are not.




I'm not saying therapy is evil or bad or that it can't help people figure stuff out. Normal people use it too....

I'm saying, FORCING me into therapy before you "let" me choose how to live my life is a problem.

Maybe this is a cultural thing though... I'm from america... where we value personal freedom.

Why isn't it required of normal people undergoing "major, irrevocable life-changing surgery" and choices?


Answer:

Because a normal person is assumed to be a free rational adult capable of deciding what to do with their own bodies...... and we, are not.

Increasingly it is.  Particularly for major plastic work.

Quote from: tekla on April 13, 2012, 04:56:50 PM
Increasingly it is.  Particularly for major plastic work.

Like?

I know its hard work to scroll up and all but...

In 2009 alone, nearly 10,000,000 individuals sought cosmetic procedures in the U.S. alone (Sclafani, 2010). With this growing interest and number of people seeking cosmetic procedures, it has also become important to evaluate the patient's motives and understand what they think plastic surgery can do for them. Unrealistic expectations or impure motives can lead to problems for both the individual undergoing the procedure, as well as the doctors involved in performing the surgery. It is for this very purpose that many individuals are now being referred for psychological evaluations before cosmetic procedures are agreed upon. And in cases when patients may not need formal evaluations, cosmetic surgeons are being trained to be more aware of what to look for in applicants for cosmetic surgery.
http://voices.yahoo.com/why-psychological-evaluations-necessary-8276069.html

The eight danger signs that surgeons should be vigilant for when dealing with patients are:
· A preoccupation with an imagined defect
· Excessive concern over a minor blemish or flaw
· A perceived flaw causing significant distress and impaired social or working life
· When their preoccupation is not accounted for by another mental disorder
· Multiple consultations for surgery
· Multiple surgical procedures
· Unrealistic expectations about the outcome of the surgery, such as wanting to look like a particular movie star
· Lack of clarity about their goals for the procedure
http://www.guardian.co.uk/society/2006/sep/22/health.medicineandhealth1

Find another TWO MILLION EIGHT HUNDRED THOUSAND articles here:
https://www.google.com/search?aq=f&sourceid=chrome&ie=UTF-8&q=psycheratic+evaluations+for+plastic+surgury#hl=en&sa=X&psj=1&ei=-KGIT47LE4qriQK02fieCA&ved=0CGsQvwUoAQ&q=psychiatric+evaluations+for+plastic+surgery&spell=1&bav=on.2,or.r_gc.r_pw.r_cp.r_qf.,cf.osb&fp=fa3850a2e10b61fd&biw=1280&bih=651