Informed Consent SRS

[Marissa]

Are there any good SRS surgeons anywhere (e.g. Thailand) who follow an informed consent model instead of the WPATH IJT SOC? In other words, where one can sign a release and pay to receive SRS right away without waiting a year and having letters.  I just think the world would do well to dispense with a lot of the gatekeeping.

[sarahb]

I don't have an answer to your question, but I do agree that the whole 1-year RLE and 2 letters is way too much to require. Everything else only requires a signature, and really SRS is the only one that isn't even visible to the world.

[Jamie D]

There used to be, but I'm not sure I would use their services.

[LauraGirl]

For dr Suporn, you only need one letter from your gendertherapist stating you live at least one year fulltime as a woman at the moment of surgery and you take HRT, again at least one your at the time of your planned surgery. You don't need two letters.

[Jessica Merriman]

Jamie is right. I would not use the services of anyone who would do it without precautions, such as letters, or offer a deep discount. I may be one of the only one's here who actually appreciate the time it takes for SRS in the U.S.A. It gives you time to really consider all the possibilities and establishes good mental health attitudes. Please don't rush this important process. Joules has a great point as well. Good luck girl.

[Marissa]

Thanks for the relies and info everyone! I first started looking into SRS in 1998, so I don't think I'm rushing, but maybe I am getting impatient. LOL 

I'm having a really tough time finding doctors who have even heard of WPATH here in Maine.  If anyone knows of any good endocrinologists from Boston north, I need to find one of those too. Maybe I could even go to Canada.  I've been meaning to get a passport anyway.  I also need FFS (especially rhinoplasty) but not sure how much I can afford.  Is surgery a lot cheaper in Thailand?  I have Medicare which currently won't pay for any of these surgeries AFAIK.

Thanks again!
Mara

[Tammy M]

If you have been looking into SRS since 1998, you have had time to meet any WPATH requirements and you haven't started HRT or RLE yet, you can do those steps and wait a little longer.  I have a friend in Maine who is on HRT and full time.  If you send me an email I can get her doctor's information for you.  I couldn't imagine anyone getting HRT without at least 1 yr on hormones, It will be 2 yrs for me, and the RLE is very well worth it because you need time to adjust to your new life.  Good luck!

[Flan]

I'm having a really tough time finding doctors who have even heard of WPATH here in Maine.  If anyone knows of any good endocrinologists from Boston north, I need to find one of those too.

The closest is probably a planned parenthood in Vermont that offers LGBT services.

[Marissa]

If you have been looking into SRS since 1998, you have had time to meet any WPATH requirements and you haven't started HRT or RLE yet, you can do those steps and wait a little longer.  I have a friend in Maine who is on HRT and full time.  If you send me an email I can get her doctor's information for you.  I couldn't imagine anyone getting HRT without at least 1 yr on hormones, It will be 2 yrs for me, and the RLE is very well worth it because you need time to adjust to your new life.  Good luck!

Thanks, Tammy.  I should have mentioned that I researched transitioning and SRS in '98 but unfortunately I decided not to move forward with it back then and I've only been transitioning for about 6 months.  I'm on HRT, but I would really like to see an endo (can't say anymore here due to ToS).  I have some RLE, only part-time though.  I would like to go full-time but not until I get more shoes. LOL 

Maybe you're right about waiting being wise, although I still resent having to prove myself to a therapist.  As far as I'm concerned, the only one with the right to make that decision for me is me.  I'll email you about the info, or you can email me if you like at marissa.acadia at gmail.com. 

~Mara~

[Marissa]

The closest is probably a planned parenthood in Vermont that offers LGBT services.

Thanks Flan, is there a location in Vermont in particular, or should I just google them?

[Flan]

The closest is probably a planned parenthood in Vermont that offers LGBT services.

Thanks Flan, is there a location in Vermont in particular, or should I just google them?

I didn't go very deep in the search since the 2 locations that were top of the results (that offer services) are likely an equally annoying distance (70 miles) away.

[kinz]

Thanks for the relies and info everyone! I first started looking into SRS in 1998, so I don't think I'm rushing, but maybe I am getting impatient. LOL 

I'm having a really tough time finding doctors who have even heard of WPATH here in Maine.  If anyone knows of any good endocrinologists from Boston north, I need to find one of those too. Maybe I could even go to Canada.  I've been meaning to get a passport anyway.  I also need FFS (especially rhinoplasty) but not sure how much I can afford.  Is surgery a lot cheaper in Thailand?  I have Medicare which currently won't pay for any of these surgeries AFAIK.

Thanks again!
Mara

hi mara! i'm drawing from a sheet i pulled up when i looked up informed consent clinics, so here's what i've got so far:

fenway health - boston, ma
mayra cruz-polanco - boston, ma. no url, but i'll throw in the name since it came up.
ellen rottersman - brookline, ma. not informed consent, but she explicitly states that she is quick in evaluating/writing letters & does sliding scale care.

If you have been looking into SRS since 1998, you have had time to meet any WPATH requirements and you haven't started HRT or RLE yet, you can do those steps and wait a little longer.  I have a friend in Maine who is on HRT and full time.  If you send me an email I can get her doctor's information for you.  I couldn't imagine anyone getting HRT without at least 1 yr on hormones, It will be 2 yrs for me, and the RLE is very well worth it because you need time to adjust to your new life.  Good luck!

hey, i feel like this probably isn't the right attitude to bring into a post like this. when someone is asking for support, resources and advice to say that someone should be doing something some other way that doesn't necessarily align with how they want to do things is frustrating and unhelpful. at least that's how i feel when the same happens to me. i feel like it's somewhat common for people to defend or champion gatekeeping as sort of a "necessary evil" or a duty or responsibility that trans people have to doctors & the community in order to transition. i think that's a really ugly habit and that it's really important to dispel it, because what marissa said is right—the only one with the right to make the decision of what's right for her is her.  it's up to each individual to decide whether they "need to adjust" to what may or may not be a "new life", and so telling people they don't know enough about themselves to make the right decision—well, i think that's wrong.

to be frank, marissa, i think as far as srs goes you may have trouble finding anyone who doesn't follow wpath/soc, which is kind of disappointing, i know, but them's the breaks. what you may be able to do is have someone who is willing to work with you to interpret the soc in ways that are most beneficial to you, and understand the need for your own autonomy and decisionmaking regarding surgery. the same goes with an IC endocrinologist. best of luck regardless

[Jamie D]

Jamie is right. I would not use the services of anyone who would do it without precautions, such as letters, or offer a deep discount. I may be one of the only one's here who actually appreciate the time it takes for SRS in the U.S.A. It gives you time to really consider all the possibilities and establishes good mental health attitudes. Please don't rush this important process. Joules has a great point as well. Good luck girl.

Just to follow up on what Jessica was saying here, this link is a cautionary tale about doctors who follow no sort of standards...

http://www.ifge.org/news/1998/june/nws6118d.htm

[Sophia Hawke]

I wouldnt trust a doctor who doesnt play by the generally accepted rules with a surgery as invasive/life impacting/and dangerous as SRS.  I personally think as far as surgeries go, spending the extra cash to go to the best would be well worth it.  And if im not mistake, the waiting list for the best doctors is fairly long anyways.

[Jessica Merriman]

Just to follow up on what Jessica was saying here, this link is a cautionary tale about doctors who follow no sort of standards...
http://www.ifge.org/news/1998/june/nws6118d.htm

For the record I DO NOT defend gatekeeping practices of unknown duration. One thing you have to consider in following the current rules is that medical providers are putting themselves in harm's way if they say prescribe HRT to a person who can not be on it because of underlying medical problems. Informed consent is great to a point. They still are under oath not to cause harm. All we need is a few cases where people use political or financial pressure on the medical community to provide service, it goes badly for the patient and then we all have problems finding medical professionals who will care for us at all. They will drop HRT and SRS in a heartbeat. The rules protect us from losing providers and services. I am one of few I guess who thinks this kind of life altering process should be slow and steady and not a blind rush with regrets later. Just my opinion though.

[kinz]

For the record I DO NOT defend gatekeeping practices of unknown duration. One thing you have to consider in following the current rules is that medical providers are putting themselves in harm's way if they say prescribe HRT to a person who can not be on it because of underlying medical problems. Informed consent is great to a point. They still are under oath not to cause harm. All we need is a few cases where people use political or financial pressure on the medical community to provide service, it goes badly for the patient and then we all have problems finding medical professionals who will care for us at all. They will drop HRT and SRS in a heartbeat. The rules protect us from losing providers and services. I am one of few I guess who thinks this kind of life altering process should be slow and steady and not a blind rush with regrets later. Just my opinion though.

yes, but.

the reason that medical providers are "putting themselves in harm's way" is because it's considered acceptable to withhold these services, and chalk it up to things like "unreliable trans people" or whatever. people don't stop prescribing lifesaving medical care like dialysis because of "a few cases"—why should the same be true of trans medical care?

sometimes "slow and steady" is not what a patient needs. sometimes they need to get out of an extremely bad, dark situation as quickly as possible, due to the amount of pain it's causing. and i think if patients know that's what they need, it's wrong to say "you aren't qualified to make this decision for yourself", especially given that trans people have been treated paternalistically like that for so long. hrt and srs can be lifesaving procedures, and i wish medical care worldwide began to reflect that.

(as an addendum informed consent MEANS you assume the potential risks of a procedure, up to and including regret. so to say that doctors are risking their jobs by providing informed consent seems to me to be a strange claim to be sure, unless there's a jurisdiction where doctors can get slammed by it regardless.)

[Sophia Hawke]

yes, but.

the reason that medical providers are "putting themselves in harm's way" is because it's considered acceptable to withhold these services, and chalk it up to things like "unreliable trans people" or whatever. people don't stop prescribing lifesaving medical care like dialysis because of "a few cases"—why should the same be true of trans medical care?

sometimes "slow and steady" is not what a patient needs. sometimes they need to get out of an extremely bad, dark situation as quickly as possible, due to the amount of pain it's causing. and i think if patients know that's what they need, it's wrong to say "you aren't qualified to make this decision for yourself", especially given that trans people have been treated paternalistically like that for so long. hrt and srs can be lifesaving procedures, and i wish medical care worldwide began to reflect that.

(as an addendum informed consent MEANS you assume the potential risks of a procedure, up to and including regret. so to say that doctors are risking their jobs by providing informed consent seems to me to be a strange claim to be sure, unless there's a jurisdiction where doctors can get slammed by it regardless.)

I'm honestly considering SRS if there enough cash after a year of being on hormones and being FT over say FFS, trache shave ect.   A yeah being fulltime on hormones, is going to be like the blink of an ey with all the growing and learning keeping me distracted from the other bits i hate.  I'm betting my priorities will likely changed during that time too with regard to my transition.  For SRS i dont think being a year fulltime and on hormones is much to ask to be honest.  For hormones, informed consent should be enough. Hormones are mostly reversable easily,  and  as long as its safe for you to be on them(and sometimes even if it isnt, if things are that bad).

[Tristan]

as Morpheus would say. there is always a way out of the matrix 
someone you know may have the answers

[Jessica Merriman]

sometimes "slow and steady" is not what a patient needs. sometimes they need to get out of an extremely bad, dark situation as quickly as possible, due to the amount of pain it's causing.

Even if rushing puts them in a worse situation by not being adequately prepared?

[Sophia Hawke]

Even if rushing puts them in a worse situation by not being adequately prepared?

Worse than death?