What do we think of self-diagnosing gender dysphoria?

[suzifrommd]

What do we think about people who don't see a mental health professional and decide to transition on their own? They learn what they need to by reading up on GID and from forums like Susan's and local support groups, and only go to health professionals for medication or surgery (presumably on an Informed Consent basis).

Please note: I am not talking about self medicating. It's dangerous to take prescription medication without a doctor's care.

[kelly_aus]

I saw a psychiatrist more to sort out some of the other crap in my life.. I knew who I was and what I needed, what he helped with was the baggage I didn't want to carry around any more. I think we could all do with a little help along the way, whether it be for a GD diagnosis or just some more general support with life issues.

[Jill F]

I think it's probably best to have a mental health professional help you sort out who you really are, but it's certainly not a requirement.

There are places in the world (and in this country) where you aren't likely to find any help and you must rely on yourself and yourself alone.

[Lady Smith]

Twenty two years ago New Zealand was a medical wasteland when it came to trying to find professional help so much of my transition for the first two years was pretty much down to me.  I can remember going to a counsellor and she spent much of my appointment time nervously looking at the clock to see if it was chucking out time yet.  When I did finally see a psychiatrist she thought I might have multiple personalities, but she also admitted to me that she knew almost nothing about gender dysphoria.  Fortunately my GP had been at the leading edge of the campaign for homosexual law reform in this country when he was younger so at least he was well disposed towards me even if he was not especially knowledgeable about folk like me.
The very first GP I saw though got hold of some ancient article from the Lanclet that said (crusty voice) 'The patient should be observed in their lifestyle and general mannerisms for two years before hormones are dispensed.......'  Or some such nonsense like that anyway, but I gave him the push when he tried to come on to me and pressed his fortunately still clothed erection against my thigh.  His wife left him three months later, I wonder why?

So yes a lot of my transitioning was DIY and mistakes were made by medical folk with my meds and very little was explained to me about the risks of being on such a high dose of Permarin as I was at that time.  Nobody told me about Potassium and being on Spiro and so it went on.

Is DIY a good idea, - no, - but I didn't have much choice.  If you do have skilled and competent therapists and medical folk in your area then for heaven's sake go and see them and follow their advice.

[pollypagan]

I think it's not greatly different from self diagnosing if you have lost a leg.

[Ms Grace]

To be honest, a lot of it probably depends on the person and the type of help they may or may not need. We know there are people who feel they have made a mistake in transitioning - whether they went the whole way or not. I know I felt I'd made a mistake years ago and detransitioned, but I also had a lot of other issues bottled up that needed addressing. I feel that, given the magnitude of the decision, and the irreversible damage that can be involved in surgical procedures we owe it to ourselves to make sure we are in the right frame of mind. As long as the psych or therapist isn't gatekeeping then it can be very helpful.

I was thinking that a system that proved we had gender identity dysphoria, that we don't have a mental health problem simply because we don't identify as our assigned gender, would be better. The psych process would be more for those who might indeed have issues that need to be dealt with separate from the dysphoria. And as we know, depression, suicidal thoughts, etc are generally caused by GID and can often be addressed by treating the dysphoria through transition or other appropriate means.

[Garry]

I am against self diagnosis in the traditional sense as you're not qualified to diagnose yourself based on symptoms you find on google or wikipedia. Also vitally, doctors dont diagnose themselves. Doctors go to the doctors like the rest of us. If they dont self diagnose when they work in the medical field then neither should anyone else who lacks their knowledge. In the case of being trans though I dont think its something anyone else can tell you. I certainly didnt need to be told. The whole 'psychiatric assessment' stuff has been a waste of time for me I just wanted to get on with it. Did absolutely nothing for me, it was all for their benefit, like proving Im really trans to them. It wasnt about it helping me to learn anything. This is a different thing to illnesses and disorders which need professional diagnosis and treatment. This is a personal sense of self type thing. We know who we are regardless of what someone says

Though there have been cases of people being wrongly diagnosed with GD and detransitioning as they were never trans to begin with, it was something else. For people who arent completely certain of who they are it would be best they do some kind of therapy first to make sure its a GD issue and not something else which could be mistaken for GD. For most of us I dont think its essential, for some of us not needed entirely. Down to the person I suppose but ultimately only we know exactly who we are and how we feel. Not everyone fits into little boxes which is what they do with checklists to 'diagnose' someone. Fit so many of the criteria then they say yes you have it. But that can exclude people who still are trans but dont fit those specific criteria. Dysphoria itself varies so much from person to person in terms of how we all experience it. That doesnt mean one is trans and the other isnt because we experience it differently. I would say a professional may be helpful for guidance but I dont think its really needed unless an individual wanted it if they were unsure themself. If we are sure then we dont need it. Its different from other things in this regard

[Kellam]

I'm in the "it depends on the individual" camp. For me, years of working through my other issues and building my level of self awareness was what it took. I have made extensive use of online peer support groups though as I knew I couldn't simply go it alone. I have problems with authority and my experiences with therapists in the past were mostly negative. I had been forced to see therapists as a youth, by my schools, and was aware that the sessions were for the school's benefit not mine. That being said, I do want to see a therapist now. I didn't need anyone to tell me I am trans or that I could transition but I do see the value in having someone to talk to while I transition. I want to come out of transition a healthier person than I went in.

[katrinaw]

I am self "diagnosed", simply never had the opportunities years ago, so I learnt to live with my condition, not even knowing what it was called, from about 4YO... But in that process I covered up and tried to be who I wasn't, if it were'nt for forums like this or more open information available in my late forties, I would have died not knowing about GID and the reality of being who I really am!

Not sure what else to add, except; these days going to therapists is easy, they can help, years ago it was not like that at all...

L Katy

[androgynouspainter26]

How the heck can anyone here even begin to say that a therapist knows better than the person their supposed to be helping in these matters?  If you feel like you're trans, you are trans.  That's pretty much all there is to it.  You know what you feel better than any therapist; therefore, it's up to the individual to realize this stuff.  Otherwise we'd be going back to gatekeeping like they used to have...

[jessical]

What do we think about people who don't see a mental health professional and decide to transition on their own? They learn what they need to by reading up on GID and from forums like Susan's and local support groups, and only go to health professionals for medication or surgery (presumably on an Informed Consent basis).

Please note: I am not talking about self medicating. It's dangerous to take prescription medication without a doctor's care.

When a person decides to transition on their own, it does not imply they will never use the services of a mental health professionals.   When therapists are the gatekeepers for HRT and GCS, it changes the tone between the person and the therapist.  There is always that extra pressure to say certain things to get through the hoops.  I don't think it serves us well.  I like the idea of informed consent, plus as part of that offering easy to access options for therapy.  I know that is not happening at the moment, but in an ideal world I think that would work.  I would be very interested to know what treating physicians for HRT on informed consent think about the issue.

I do find it a bit ridiculous that for everything besides GCS (and sometimes HRT), you need to get the approval of a therapist(s).  For all the rest, including some very involved non-reversible surgeries, there are no hoops to jump through.  I also can't understand why a person who is on HRT, and is full time for over a year, needs to jump through the mental health hoops to have GCS.

[Cynobyte]

I've noticed the ones who self diagnosis then use hrt seem to know their dysphoria better before any surgery.  The problem is getting from that self diagnosis to a dr who will help them with hrt.  I've noticed the dysphoria as in my case was resolved with hrt.  I just can't understand why a dr would make a dysphoria patient wait up to 2 years before administering hrt..  I could see higher rates in depression and suicide..  I saw a shrink on my drs request, but I could have convinced him i wanted to be a cat!  I still see him since i need to as my drs requirements. But sadly, i wouldnt send someone with real issues to him.  My councelor on the otherhand who i actually served in the same squadron when we were in, ive been seeing her weekly for years before this.  Shes not qualified, but shes awesome.  She even is working on something so she can help other tgs like me..  Around here tgs are mostly comming out of the military:) So, after my paper diagnosis, My Dr was hesitant to start my hrt out of too much literature going too many ways?  I just told him while he is learning about this, to please start monitoring my hormone levels since I've already chose my hormone  course and was already on it.  My body, my life, my choice!   He started my labs for me at least and 2 months later finally came up with a prescription that was 4x the dose I am currently taking.  He's been in his field 18 years and well liked, but just never did this.  Fortunately I sat him down and went over my issue with his prescription.  Moral of the story, don't always trust your drs either.  Always get your scripts and research everything.  Can you imagine taking 4x the normal estradiol injection dose? I'd rather argue about it than follow blindly and argue after the consequences, possibly death! 
Even research your dysphoria..  there are too many sites out there with incorrect doses and treatments, but something should make sense and line up to your treatment ..  or just ask someone undergoing the same treatment if what you are on is normal.  This site doesn't want to give out dosing for a good reason, but I hope we all can tell you if your current treatment may not be good for your health..  Last, there are different treatments, please research and know them before starting.  Not all work for all of us..  By knowing other treatments, you may be less discouraged if the current one is not to your liking.  This should be common knowledge,  just like when I started chemo, I was not going to take my drs word for it.  They maybe nice, but do you know them enough to know they are not paid to lean twards a certain prescription or treatment for money?  It happens everyday.  Sorry 10 years down the road just doesn't compare to a great life if you do it right:)

[Cindy]

This is a complex area and one model doesn't fit.

Some of us are clear in our minds and have accepted who we are, some others may have DID which needs exploring, others need confirmation. There is also an increasing presentation of cross dressing men who are unsure if they are MtF but want to explore how they feel. Gender reassignment is problematic in this group. Why there is such an increase in this group is unclear but possibly due to internet access to such sites as Susan's enabling people to question their gender identity.

The increase in people accessing the gender clinic that I have a loose association with has blown out waiting times from a few months to 6 months plus. Which is hard for everyone involved.

The hardest group is children. In general (and yes it is in general) if a young child (4-7) starts to gender identify as opposite to GAAB then it tends to remain stable. A high proportion of 11-15's who start to identify as opposite to GAAB remain fluid and can revert back to GAAB at around 18-22, this proportion is higher in FtM than MtF. But in both groups there is a significant group who decide to revert to their GAAB and identify as homosexual and are very happy in that identity.

So my feeling is that yes there is a need for medical professional to assist us; but, and this is a major caveat, the professionals need to be properly trained professionals in the area of transgender medicine who know what they are doing.

[Rejennyrated]

Well having gone the self diagnosis route, and then gone on to have 30 good years, I obviously cant object. Then again I agree with Cindy one size will not fit all and my own history is decidedly odd.

In many ways I transitioned several times. My parents disapproved of enforced gendering and hence I grew up as what I believe might now be called a demi-girl, having expressed a strong gender preference for female at age 4 or 5. I was very lucky - to find a family and schools that allowed me that freedom in the 1960's in the UK was pretty unusual but I'm living proof it happened.

Then in 1976 I sought to complete the transition and came up against a lot of very unsympathetic medics with result that with puberty biting and no help, I was forced to transition to male...

Finally in 1984/5 I took matters into my own hands. I transitioned to female, I obtained medication, I obtained SRS, but I managed to do that all with very minimal medical involvement because frankly having been blocked once I wasnt in a mood to let anyone have even the slightest input to what I was doing. For me that worked, and there might be others for whom that would also be the case, but for most its probably not the right way to proceed.

[FTMax]

As someone who has had experiences with multiple therapists, begun HRT via informed consent, and ultimately worked with a therapist to get a referral for surgery, I recognize that there is a benefit to having multiple systems available for people to transition. I would not be the person I am today had I been stuck waiting several months to start hormones, and for that reason alone I'm thankful that informed consent exists.

But I do not believe in self diagnosis. To me, only a competent medical professional can say that I have a condition. And with a complex condition like GD, I think there is value in getting a second opinion. When you think about the amount of money you will spend on transition over the course of your life, of the social stigmas and hoops you will have to work around, getting the opinion of a competent, affirming, and friendly professional is probably the least difficult thing you will do. Especially in this era when there are so many options available for decent long distance care.

I think it should fall into the category of other chronic, manageable mental health conditions. If you have seasonal depression year in and year out, you go to a doctor, discuss it, and they make a treatment plan that you follow until you feel better. Speaking with a mental health professional for GD is the same - you go in, discuss it, and make a plan to make changes until you feel better. It's no different.

Ultimately - to each their own. I'd never impede another person's transition. I'd much rather have people present and living, even if they end up feeling like they've made a mistake.

[Cindi Jones]

Don't we all self diagnose this thing? I mean don't we just know? I remember those thoughts since I was only 3 years old.

But I think it depends on a number of factors. Usually it's learning how to deal with all the negative crap you get from family, friends, and coworkers.

I was invited by a therapist to panel a transgender session at a community college in southern CA. Every semester, I'd go down and do her class with three other transwomen. I had not had my surgery yet. I paid for one session with her after doing three classes and she wrote me one of my letters. I also attended a group therapy thing that was free in Santa Monica hosted by Jayne Thomas. She worked as an advisor on films that involved the topic. She really liked my input in the group. I participated for a year there. I paid to see her twice to get my other letter.

Now, I saw three good church member "therapists" in Utah before I moved to California. I saw them a lot. They tried to cure me. They put me on drugs where I'd zone out and lose several hours in a day. I'd wake up in a meeting and wonder why I was there. They tried electric shock therapy and a bunch of other senseless crap. I paid them about $15k combined. What a waste of money that was.

Cindi

[Dee Marshall]

The DSM V definition of gender dysphoria basically calls for self diagnosis verified by a therapist. If you say you're trans, you are absent the existence of a very few serious conditions that MIGHT mimic it. Even then it doesn't mean you're not trans, just that you have to deal with the possibly obscuring conditions to be certain.

[androgynouspainter26]

The DSM V definition of gender dysphoria basically calls for self diagnosis verified by a therapist. If you say you're trans, you are absent the existence of a very few serious conditions that MIGHT mimic it. Even then it doesn't mean you're not trans, just that you have to deal with the possibly obscuring conditions to be certain.

What could possibly mimic this?  If someone feels like their in the wrong body, are we to simply invalidate that feeling if thy have other issues?

[Dee Marshall]

What could possibly mimic this?  If someone feels like their in the wrong body, are we to simply invalidate that feeling if thy have other issues?

Supposedly serious stuff like schizophrenia or dissociative identity disorder.

[femmebutt]

I think dee is referring to multiple personality disorder - best guess...