This is a rather old post on another forum that I came across but it made me wonder. I was under the impression that it's not as bad as this poster makes it out to be, but maybe I'm wrong. For instance, I know of a couple of cases where someone only took T for a period of time or only had top surgery or some combination such as that and it didn't seem to be difficult to get approval.

Are they more restrictive specifically with regard to bottom surgeries? This post had only one response and it was from someone in the same boat as he just agreeing with him. I'm just curious about the law because it bothers me when people use the government to restrict people's choices that only affect themselves and was curious if anyone here had experiences that might enlighten on that subject.

QuoteMost body mods are legal from simple tattoos to piercings, even genital piercings, scarification, dermal implants, and so on. But there are some mods that are conditional or just plain illegal to do safely. Most of the time when people seek to modify their bodies it is to make their bodies reflect who they are inside, like the lizardman for example.

It seems the law has no problem with people painting themselves with ink or poking holes in their bodies and inserting jewelry but when one wants to remove a body part especially genitals the law wants to get involved and restrict such mods from being done safely with trained surgeons.

With me its the desire to have only my genitals changed to the opposite sex but according to the law I can't do that. In order for me to receive such surgery the law requires me to become totally opposite the sex I currently am. But I don't want to go that far.

Even though I do have gender identity disorder to some degree it isn't full blown like a person who truly feels they are the opposite sex. I am in the middle, intersexed in my mind, both male and female at the same time. My body is not the way I want it but I don't want to go full blown female.

I want to feminize my body in some ways and leave it alone in other ways. I don't want to legally change my sex. I want to change my current genitals into a vagina which is possible and leave the rest alone. I may decide to feminize more later but at the moment that is all I want, a vagina.

Why can't I just have that done instead of making a complete switch? I've thought about nullo but that totally removes the ability to have sex, outside of anal sex, which isn't what I want. I still like sex and want to be able to have sex. I want to be like Joe the Mangina man or Buck Angel (yes I know Buck is genetically a female).

Why can't I be like that? I don't mind going through extensive psychological evaluations to get approved for such a surgery I just don't see why they won't even consider it without agreeing to go through a complete transformation from male to female when that isn't me.

I know it is still possible to get it done but the risks are to high because you don't know if the person performing the surgery is trained or uses the latest in plastic surgery and often times you have to go out of country and there is no guarantee that you will get the results you want.

At least if a trained professional does it in a hospital your are more likely to receive good care and can be safe and are more likely to receive the results you want. Plus, with that type of surgery there is aftercare that is needed like followups and maintenance.

This type of mod is very similar to a true transgenders situation where the psychological effects can often lead to one to cause self harm or seek the procedure from dangerous sources.
By making the surgery legal without the transitioning but still requiring extensive counseling to get approved for it the US and other countries that ban it without transitioning can greatly reduce people making poor choices because it is the only one they have and help those of us who wish to modify our bodies to match our mental image of ourselves irregardless of what type of mod it is live a much happier and healthier life.

In a free country people should be able to do what they want with their bodies and the doctors the would perform those procedures should be protected and free to choose whether or not to perform such procedures.

Did I put this in the right section of the forum? I noticed it has very few views.

As far as I know, in the US getting bottom surgery can be difficult without jumping through psychiatric hoops, but I'm not American so I'm not entirely sure of the situation. Typically you need 2 letters (I think?) from two different therapists confirming that you've undergone therapy, been diagnosed with GID blah blah blah. I think it depends on the therapist, because there are some who won't give you the letters if you don't conform to what they think "trans" or male/female is.

Here in Canada, from what I know, if you are getting your surgery funded by government healthcare you need to be fully transitioning to male/female. Even getting top surgery through CAMH over here can pose problems depending on the therapist and if you aren't fully identifying as male/female, or if you're a transguy who isn't "masculine enough" or transwoman "feminine enough." Some therapists (to give you an idea, Kenneth Zucker is the head of the GID clinic here at CAMH and he's the biggest player perpetuating this garbage) even believe that it is "impossible" for a trans people to be gay or bisexual and that can be another obstacle to getting surgery. So being a trans person who doesn't fit the stereotype of masculinity/femininity or heterosexuality can mean denying a person from getting government-funded surgery. I imagine bottom surgery is even worse if you're someone who doesn't fall into the little box they want you to fall into, or who doesn't identify as male or female but wants to have bottom surgery.

Over here you don't need to be officially diagnosed with GID or have a letter if you want to get top surgery that you pay for yourself or through a loan or line of credit. Bottom surgery I'm not entirely sure, since I've never known anyone who's been able to pay for it themselves. But as far as I know, letters are probably still required for bottom surgery...which means its entirely dependent on your CAMH therapist and how they "officially" diagnose you.

Not sure if that answers your question very well But yeah, there are definitely government restrictions in most countries when it comes to bottom surgery and who is/isn't eligible for it, and definitely puts greater restrictions on bottom surgery than on top surgery.

Thanx for replying, Berzerk. I was thinking this thread was just dead.

I don't know the entire answer to your question. I think it probably has to do with our society's need to have people one thing or another. As for Zucker. he is well respected on some circles and totally not respected in others. HERE IS PART OF THE PROBELM - not enough of us are going into this field and publishing. He has the most publications to his name - the fact that many of his conclusions are biased is rarely brought up. The are professionals in this field who are disagreeing with him, as I do. When I am done with my Np I hope to be able to conduct some research to refute some of his claims. There are others doing it now. Just not as wildly read.

part of me just thinks, if you don't like the way things are going, go into the field and have your voice heard.

Hi,

What laws are you talking about , i would have no idear.

im   intersexed, & live as a woman  though it would not have mattered if i lived as male, & weather you have surgery or not does not change who you are.

Okay im a Kiwi from New Zealand.

For most trans most see thier Gp & say they belive they are a woman traped in a male body ,
Then most then go see a Pysch some to sort out some details maybe over time .

if they then are sane & body wise no health concerns, they will be put on meds H R T. then later could be 2 years or more have surgery & then live as a woman.

In N Z your wasteing your time if you think youll get help for surgery from the Govt 14 years a long enough wait,  cost over 40,000 kiwi $  Austraila about the same.


Okay you know im intersex,

I told the G p i am a woman & will be liveing as one age 57 at that time .I spent 3/4 of an hour with our Pysch was signed off & told go & live your life,

I then went to our Endo with in 3 months at my requst was on Homones , with in 3 years again at my requst had surgerys,

Not in N Z  , i went to Thailand  Phuket under Sanguan, cost all up 16,000 trav live expence & my stay was 23 days,

Now i did not tell any one at the time i was / am intersex because it would have not been worth the hassel .& i was right at the time not saying any thing,

Now yes you can have surgerys .= only for breasts or S R S or what ever you need,  you pay you can  have it,  allthough they have tightened up a bit for govt regs its still not a issue they have thier own Pysch who will see you just for the paper work & normaly youll be cleared,

My difference was i told the Dr's concerned what i had done what   i was doing & what i was going to do. no ? asked as there was no need.......  i do know my own mind ........im not a kid & i can tell you i wont be treated as one. & i dont take any bull->-bleeped-<- when i say im doing something .

what you need to remember is if your not a 100% sure & you need to discuss your issues then you may  not be ready for meds surgerys, this is what it comes down too, any doughts then its to open to the not sure then the ?s . my case , it was this ....IS.... what ill be doing.

I know the hoops they go through in the U K, & could  be similer in the U S.

That is of cause if your applying for the govt funded side of things if your paying then thats different,

First off i would have a chat with a Pysch or your G P.

As a point of interest i never had G I D, & did not jump through any hoops & as to the A P A or wapath  what ever it is we dont follow that ,  though some may .

I do know in Christchurch the surgeon & his Pysch's are to long winded & i sure as hell would not see them or have surgery by the Surgeon there, & would have had to wait 14 years.. 

Not bloody likely, i can tell you,

So you do need to look around,

...noeleena...

Most countries require a year or more full time with 2 letters from different professionals for SRS. So, this person would most likely have to undergo some form of transition under therapy. I'd recommend they see a gender therapist if they're serious about this. The therapist can help them sort out their needs and plans.

Quote from: Forum Admin on August 01, 2012, 02:59:54 AM
Most countries require a year or more full time with 2 letters from different professionals for SRS.

I think that's the issue the guy is talking about. Most governments still see gender as strictly binary. They only respect the decision if you intend to 100% transition which is not what this guy wants. He seems sure that he wants surgery for his dysphoria but he also seems sure he doesn't want to transition in the other ways like hormones or top surgery or any other surgeries like FFS. He's also willing to go to a therapist to sort of back him up but I'm sure a lot of therapists still view gender and transition as a black and white binary thing rather than as a spectrum and I'm sure it will be a challenge for him to find one who understands intersex conditions. Then even if he does, it will be maybe an even bigger challenge to find a competent surgeon who would respect letters of recommendation.

The notion of a gender spectrum is something that I've become more familiar with by being active here. For me it's just academic and this is just one example of someone who falls somewhere in the middle of societal expectations of binary gender.

Quote from: dalebert on August 01, 2012, 09:52:03 AMThe notion of a gender spectrum is something that I've become more familiar with by being active here. For me it's just academic and this is just one example of someone who falls somewhere in the middle of societal expectations of binary gender.

Which I think is really ->-bleeped-<-ty that the psychiatric community thanks to the likes of Zucker continue to be focused on the binary and making perfect little "trans" candidates. Its getting better in so far as top surgery no longer requires letters or a strictly a male/female identification. The surgeon I went to for my surgery gave me the impression that they were getting more non-normative people wanting top surgery who weren't always necessarily identifying as transguys (though transguys I think will probably always be the majority). He only wanted what seemed like a pretty basic rundown of why I wanted the surgery and so on.

It used to not be like that for top surgery...so I think now that its become easier to get top surgery and T without an official GID diagnosis + the go ahead from psychiatrists, that getting less strict on bottom surgery will happen in the future. We're not there yet, but I think its the only logical direction to go in. Maybe then it'll be more of an option for people who occupy more of a middle ground as far as their gender/sex and less red tape to go through...I hope so anyways. If I can still be a transguy while not wanting bottom/getting bottom surgery, then why can't someone continue to be who they are while getting bottom surgery, but not wanting hormones or top surgery...Doesn't make sense, imo.

Quote from: henrytwob on July 31, 2012, 03:40:52 PM
I don't know the entire answer to your question. I think it probably has to do with our society's need to have people one thing or another. As for Zucker. he is well respected on some circles and totally not respected in others. HERE IS PART OF THE PROBELM - not enough of us are going into this field and publishing. He has the most publications to his name - the fact that many of his conclusions are biased is rarely brought up. The are professionals in this field who are disagreeing with him, as I do. When I am done with my Np I hope to be able to conduct some research to refute some of his claims. There are others doing it now. Just not as wildly read.

part of me just thinks, if you don't like the way things are going, go into the field and have your voice heard.

He may have respect from psychiatrists who think like him, but he doesn't have a lot of respect from trans people in this city. I found alternate means of getting top surgery largely because I didn't want to have to go through CAMH and Zucker's judgements of whether or not I was "trans enough." A lot of people don't get surgery, try to find other ways financially or end up hurting themselves because of him and his ideas. So I don't think its a black and white issue of "some people respect him and some people don't" when he's playing with people's lives.

Personally, as much as I wish psychiatry would change, I have zero interest and very little respect for the field of psychiatry and no desire to get involved in it. I just think its screwed up on so many levels. I'm more interested in trans activism and groups that are actually making baby steps in the streets, in prisons and legally for trans people here. Men like Zucker will soon be obsolete by the looks of it, given the number of people who have complained about him and how much criticism he gets from LGBT health centres, professionals and activists.

This topic implies that these are all legal issues, by and large, they are not.


In general, there are no laws (I certainly have yet to see any from any country) that say you have to see a doctor for X amount of time or have Y letters or Z amount of therapy. The law has nothing to say on those matters in by far the majority of countries.


What the law of most countries DOES say, is that many drugs require a government authority (e.g. a prescription) to supply, or in the more extreme cases (with drugs of addiction or other special cases), an authority to possess. Nothing we take for HRT is above the mildest realms of drug restrictions in any country I'm aware of (although some countries do have regulation that precludes the supply of certain drugs, but only for bureaucratic reasons).


Nor has any legislation I have ever seen governed the surgery aspect, outside of the fact that surgical procedures must be performed by people with such and such credentials and other technicalities.


These restrictions on us, the therapy, the indoctrination into the medical establishment, it's because of self regulation and fear.


Where the law and judicial system is culpable, is in not making it clear enough that informed consent waves your right to sue (or to be more technical, it waves any expectation that you could win), and not properly taking care of frivolous lawsuits.


Because of that, we have self regulation in an attempt to not get sued.


But I digress, doctors enforce these restrictions on us because they have the legal power to do so.


Ok, now after this portion of the post, I'm going to discuss what we can actually 'do' about it, but in its very nature it's vulnerable to suppression, so moderators, I ask you kindly, I am stating now I am NOT telling people to break the rules and I am NOT telling people to self medicate, I am giving my view about what COULD be done about it, and why I'm so cynical that nothing will change anytime soon. If you must censor my post, please limit the censorship to portions of the post beyond this point.



With that out of the way, now that I've explained how the system currently works, here's how I think it SHOULD work.
This forum is such an example, susans is based in the US, with constitutionally protected freedom of speech, there's no legal reason susans should need to suppress discussion of certain topics because they hold no legal liability. Someone COULD sue them, but someone COULD sue you for virtually anything, they wouldn't win though because they have no case.


The fear of it keeps the regulation going. And before anyone says anything, if you argue that suppressing discussion of a topic is in the interests of those you're suppressing it from, be mindful that you're also advocating similar failed ideas in the form of abstinence only sex education, drug education, etc. Harm reduction is a well proven concept.


I believe once you're over 18, you're an adult. I do think we should make an effort to keep people from making mistakes, but ultimately I don't believe we have the right to FORCE them not to make mistakes that will only harm themselves.


With that in mind, I think we should legalize the purchase of 99% of drugs without a prescription, the prescription system exists to keep people from hurting themselves. But it's all just an illusion. Drugs in one country are illegal in another. Acetaminophen/Paracetamol is sold in packets of 100 of 100mg for 2$ here in Australia. That's enough to kill someone several times over, and it's virtually completely unrestricted. If you believe as I do that the system should be about doing things rather than APPEARING to do things, then either you think it should enforce drug prohibitions based on merits or on principle, I would prefer the former, but in either case the current system is absurd.


Same with surgery, informed consent model.


If you want to get it on the public dime, and can't pay privately, then yes I agree there should be a system. But given how rare our conditions are I don't think it need be very restrictive. And I absolutely don't agree that any therapist should be able to set an arbitrary and indefinite limit.


Now we all know that's never going to happen, not likely in our lifetimes anyway.


So what should happen instead, well, we should stand up for ourselves. At the very least we could stop censoring our own communities out of the very same fear the doctors use to control us. And we could stop defending them.


There are certain people in our world who's seemingly sole purpose in their life is to suck up to the establishment. Most of the time I think they foolishly believe that by supporting the system it will protect them, which it won't. Or they WANT to believe the system works and is in our interests, particularly if the system hasn't screwed them over as baddly as it has some of us. You want to believe the world is just and it's hard to do that if you're impartial and scientific about society. Or maybe they're just little hitlers. Irrespective of why, I don't believe any authority is above question.


All of this, the problems we face, the problems everyone faces, it's all ultimately caused by the same thing.


Despite having the gift of our level of human intelligence, so many of us don't actually want to think, don't want to question. Aren't willing to ask if the systems and designs we grew up with actually make sense. Use reason and logic.


Unfortunately these failings are innate to a majority of the population, and until the next great enlightenment with science is put in its rightful place as a decision making force and we accept that we don't have to control everything and everybody, these problems will continue.

Quote from: Asfsd4214 on August 01, 2012, 11:11:28 AM
These restrictions on us, the therapy, the indoctrination into the medical establishment, it's because of self regulation and fear.

Thank you for that well thought-out response. That's the impression I was under as well. I met a guy who said he had undergone a very similar procedure. He had a particular medical situation that seemed relevant (cancer that had reduced the function of his genitals severely), but he found both a therapist(s?) and a surgeon who was willing to help him ultimately.

QuoteI am NOT telling people to break the rules and I am NOT telling people to self medicate...

I'm pretty sure it's not against the rules to express a political opinion like that the drug war should be ended. I share that position. I've said before that I don't think drugs should be legally withheld from people.


That said, I think it's a very bad idea to encourage people to self-medicate or to teach them how and I think that's what the rule is about. Even though I believe you should be allowed to without going to jail, I don't think it's a good idea. I would rather we had a world where people had more access to qualified medical guidance and were taught the importance of seeking such guidance for any medical decisions for their own safety. In short, I don't think a prescription should be legally required for medicine but I do think it should be highly encouraged.


I'll reiterate that people are more likely to become desperate and pursue dangerous alternatives if there are too many barriers to the safer route whether that be legalities, the fear and self-regulating you mentioned, or cost.


In this case, the guy's post is sounding really desperate already. I can just picture him getting frustrated with therapists who won't empathize with him. Then if he makes it past that, the next barrier will be surgeons who won't respect the letters from those therapists. If his dysphoria is bad enough, eventually he'll start looking outside the country to surgeons who are willing but perhaps not as well-qualified and his results or even his health will suffer for it.

Dalebert, how old is that post? The current standards of care have the latitude for this person to move towards congruence, and the next DSM (DSM-5, 2013, in draft) has removed the requirement for a binary identity.

It will be up to the doctors themselves, who would be at risk for malpractice suits from patients (and conceivably others in the patient's life). And when there is insurance coverage, those requirements are often stricter than the SOC. But  a willing doctor, who is assured of the patient's ability to make this decision, has the framework right now to do this surgery.

As far as I can tell, the only legalities involved up front are US standards for changing ID documents; and the fact that, yes, surgeries must be performed by medical professionals in safe environments. (That's why cases like the recent silicone injection horrors are crimes, even though the women who obtained these procedures gave consent.)

Quote from: dalebert on August 01, 2012, 12:23:38 PM
That said, I think it's a very bad idea to encourage people to self-medicate or to teach them how and I think that's what the rule is about. Even though I believe you should be allowed to without going to jail, I don't think it's a good idea. I would rather we had a world where people had more access to qualified medical guidance and were taught the importance of seeking such guidance for any medical decisions for their own safety. In short, I don't think a prescription should be legally required for medicine but I do think it should be highly encouraged.

I agree it's a bad idea to encourage people to self-medicate in probably the majority of circumstances, I just define 'encourage' in much stricter terms, I interpret it as actual direct encouragement.


Lets use the drug metaphor again.


We know that statistical evidence shows the effectiveness of having a safe supply of clean needles for intravenous drug users, we've shown that such policies reduce the prevalence of HIV and other infections in the general community, including the non-drug using community because of course the IV drug using community lives alongside the wider community.


Despite this, many have and do argue that these policies are encouraging drug use, and condoning it. The statistics have never to my knowledge shown such a correlation.


This phenomenon holds true for many harm reduction policies. Safe sex education is criticized as condoning and encouraging teenage sex, but we know that with abstinence only sex education, they still have sex, but overall rates of std, unplanned pregnancy, etc, go up proportionally.


If our community allowed open discussion of medications, what our doctors are doing, we could compare with each other, and have better questions and arguments to bring to our doctors to get the best outcomes for everyone. Pick virtually any illness you can think of and there's a forum with a community discussing it. But in almost none but the general transgender community is it even considered that it's not in the patients interest to compare with each other.


Now obviously the counter argument to that is to suggest that our community is different because our community is more likely to self-medicate. I agree it is, but I feel the benefits still far outweigh the cons.


Our communities treat doctors like our gods and happily hand over our money to them year after year for the most basic level of training required to do what they do for us. We like to pretend they have extensive training to cover our condition, but we forget just how small we are.


You can argue that discussion of medications by extension indirectly promotes self-medication which indirectly exposes forums like this to legal liability. But like I said, freedom of speech, and no other community dedicated to discussion of chronic medical disorders (which is what I consider most of us to have) worries about such 'whatifs'.


But alas, my words will likely change nothing, I'll be told that the right way to go about this is to contact susan privately, which I did and didn't receive a reply. Despite the futility of it, in good conscience I can't not advocate something I feel would be of significant benefit to the community. It's just part of who I am... I argue, I argue for what I believe is right.

It's too hard to sum up all these posts.
Anyway there are surgeons who will do top surgery on people who are not ftm transsexual. I believe that Garramone and so on will even do it with people who are not at all transgender but have severe chest dysphoria. (Some of them have been youtube and I think may actually be transgender but not binary).


There are also doctors prescribing T or E to non-binaries. These are not people going off and doing it by themselves. It is probably harder to get insurance, but non-binary people can have even severe dysphoria.


Our Trans center does needle exchange for IV drug users. Strange as it may be New Mexico has one of the most liberal needle exchange programs in the US. As a group that practices "harm reduction", there are people in our support group that have used illegal T or even steriods. What they try and do is get these people to a doctor who does the kind of T you can get by signing waivers. That way they can get them to doctors and get them checked out, and so on. It does no good to try and lecture them, imo.


I can't really comment on MTF SRS. I believe it is more irreversible than even ftm chest surgery, as I suppose you could theoretically put silicon implants in a person with chest surgery.




--Jay Jay

Quote from: Berserk on July 31, 2012, 11:20:45 AM
Over here you don't need to be officially diagnosed with GID or have a letter if you want to get top surgery that you pay for yourself or through a loan or line of credit. Bottom surgery I'm not entirely sure, since I've never known anyone who's been able to pay for it themselves. But as far as I know, letters are probably still required for bottom surgery...which means its entirely dependent on your CAMH therapist and how they "officially" diagnose you.

Yes, you still need letters, but they don't have to come from CAMH if you are doing it privately. I know that CAMH is supposedly not as bad as it used to be, and Zucker doesn't deal directly with patients now, but I was still scared that I'd be jerked around for 2 years and then get denied, or have to play dress up and lie to get my surgery. I went to a therapist that didn't care that I wasn't entirely binary or about my non-femme presentation or that I'm queer, and I was privileged enough to be able to afford it myself so...

But there are definitely limits. She wouldn't have given me a letter without being on HRT for a year or without changing my gender markers / name. And I'm also not sure how much my passing-privilege affected her willingness to write the letters despite how I present / identify. I was also... a bit careful about how much I talked about how I identified, mostly the conversation stayed limited to physical transition-related stuff. But I did tell her that I see woman as a label that society attaches to female-bodied people, and I really don't care very much about it. That transition to me was a body thing and not a gender thing. And I showed up in my typical andro gear including some men's wear, without it bothering her. And she knew I'm gay. So ya. Some leeway is possible, but I don't know how much - probably not enough for that guy.

As far as the surgeon himself goes? I get the impression from Brassard that that area is for the therapists. He gets the letters, he does the surgery.