Therapy is really the worst idea ever.

[Jean24]

It's a huge waste of time for transsexuals. This is a physical problem, not a mental one which is why we treat it with hormones designed to alter the body along with surgery. The APA has said that gender disphoria is not a mental disorder. Other people who don't have ovaries/testes or have genital or facial reconstruction do not need months of therapy in order to be carefully guided through their journey. Their endos and doctors simply prescribe their medication without them having to go through hell and back with all kinds of signatures, diagnoses, letters, and so on. It's a scam designed to make trans lives as hard as possible for the sake of making them question, give up, and turn back at every possible turn. It's nothing more than discrimination based on gender and sex. Not only do they not help but this constant prodding makes it worse. They rile people up who maybe had been harassed at work or something or are having dysphoria pretransition and when they react negatively they're depressed, they need medication, they need anti psychotics, they need CBT/DBT.

The evidence shows biology and not psychology is the cause. All of the major mental health care institutions have already stopped classifying it as mental. SO it's time they finally butt out and leave it between medical doctors and patients.

[Moyshe313]

I agree. 6 months of seeing a therapist for her to write a note saying I'm in my right mind. Waste of time and money

[Jean24]

I agree. 6 months of seeing a therapist for her to write a note saying I'm in my right mind. Waste of time and money

You're absolutely correct. Other people do not have to deal with this.

Your avatar made me tear up

[Moyshe313]

You're absolutely correct. Other people do not have to deal with this.

Your avatar made me tear up

Thank You. I found it on google images and really was a good depiction of how I feel.

[kelly_aus]

Two things come to mind when I read things like this..

Firstly, it's not impossible you had crap therapists, sadly they exist. Secondly, you've completely missed the point of therapy, this also happens to those who think it's a waste of time.

I found therapy to be handy. Not because I was mentally ill, my psychiatrist was always quite clear that my mental health was good. Why did I find it handy then? To offload parts of my past that I had no desire to carry around any more. To help deal with the parts of transition I was mentally unprepared for.

Due to some archaic laws in my location, I had to do 3 months therapy in order to start hormones.. I've since found out that my therapist was prepared to write my referral for HRT after the 1st session.. My surgical referral is sitting in my file.

[becky.rw]

If your therapist was not your gatekeeper, would you see this differently?    I'm just suggesting that maybe you're upset about something that has been basically fixed at the root now, and is just a matter of time and familiarity of the system with the current guidelines, both WPATH and IC.

In general, at least in the US, if you don't like your doctor or therapist.   Fire them.   No one will throw you in jail for firing a doctor.

If you want the services of a particular individual, then you have to let them do their job as they think best.

If you really want to move the process along without much help, the informed consent model is real, and available, and used.   Go to one.

If you want to have a radical impact on transgender care, go to med school, do your time, and then you can make up your own darn rules about which model to use and where to use it.  (and try to figure out how to make a living doing it.)

[Laura_Squirrel]

Meh. It is what it is. Sure, I still remember how annoying that 8-month long wait for my HRT letter was. But, it was worth it in the end. It's just the way that it goes.

[Moyshe313]

If therapy worked for you. That's great. For me personally, 18 sessions of talking to someone about how I don't feel like a man and internally feel female got old quick. I could see a having to sit down for a session or 2 just to make sure you have your stuff together.

[Jean24]

Two things come to mind when I read things like this..

Firstly, it's not impossible you had crap therapists, sadly they exist. Secondly, you've completely missed the point of therapy, this also happens to those who think it's a waste of time.

I found therapy to be handy. Not because I was mentally ill, my psychiatrist was always quite clear that my mental health was good. Why did I find it handy then? To offload parts of my past that I had no desire to carry around any more. To help deal with the parts of transition I was mentally unprepared for.

Due to some archaic laws in my location, I had to do 3 months therapy in order to start hormones.. I've since found out that my therapist was prepared to write my referral for HRT after the 1st session.. My surgical referral is sitting in my file.

Well believe me, I didn't think it was a waste of time for transgender people when I first started 3 years ago. I thought there was good reason for it, therapists had to help me before. Seeing that therapy was a waste of time for transgender people had to develop, but since that therapist I have seen 4 more therapists and the things the do just aggravate a sensitive subject. Letting them into my life has become nothing more than appeasement for the documents that I need because this isn't a mental problem that they are actually going to help me with.

My first was a social worker who charged me $100 a session. 6 sessions in she found out I was upset about being transgender. She said I was depressed and she would not give me a letter for estrogen until I got on anti depressants. I walked out and never spoke to her again. After that I had to be calculated and lie about every feeling I had to my next therapist just to be safe. I didn't really trust being honest with them anymore and I took my time to not make it look like I was rushing for my hormones. That's the kind of BS you have to go through as a transgender person apparently - otherwise you get the gate slammed shut and hundreds of dollars and six months wasted. Next was a Freudian doctor that said I just want to have sex with my mom because I was upset that circumcision is legalized sexual assault. I saw him twice but that was the last straw. I started seeing another therapist when I moved last year. Similarly high rate and tried all of this crazy EDRM with vibrating paddles and meditation. She was the nicest so I kept going in case I needed a letter - but then one day I was feeling so awful that I told her everything and she sent me to the hospital for a nightmarish experience. Now I'm seeing someone for free which is nice, but she's still the same as the rest.

I don't trust them anymore because they have betrayed it and because there is absolutely no reason to see them JUST for being transgender to begin with.

[Jean24]

If your therapist was not your gatekeeper, would you see this differently?    I'm just suggesting that maybe you're upset about something that has been basically fixed at the root now, and is just a matter of time and familiarity of the system with the current guidelines, both WPATH and IC.

In general, at least in the US, if you don't like your doctor or therapist.   Fire them.   No one will throw you in jail for firing a doctor.

If you want the services of a particular individual, then you have to let them do their job as they think best.

If you really want to move the process along without much help, the informed consent model is real, and available, and used.   Go to one.

If you want to have a radical impact on transgender care, go to med school, do your time, and then you can make up your own darn rules about which model to use and where to use it.  (and try to figure out how to make a living doing it.)

Well unfortunately for me I don't have that option - to fire them that is. It takes me 6 months or so to get my insurance to cover my medication. Every time I'm prescribed something, they INSTANTLY put it on hold and will not cover it. It happened with Lupron and now that I'm switching my estrogen to pill form they're doing it again. They want all kinds of diagnoses, letters, doctors notes, signed forms, etc, even though they ALREADY have them on file for my other prescriptions. The therapist and doctors that I have stuck with longest are fairly proactive with sending this stuff in, but often times they're forced to create it to "prove medical necessity." I suppose the prescription for estrogen isn't enough even though it is depending on how cisgender you are. Some people can fire their therapist and buy their own stuff and say the hell with all of this. I can't, and it is a form of discrimination based on class.

I've been on HRT for a year and a half and getting prescriptions is a nightmare because they choose to include mental healthcare professionals who have no business being there in the first place when it comes to your medical care.

I'd also like to see where informed consent is a REAL option and not just some occasional hole in the wall operation. 

And finally, that last part is a gem. While I'm sure you'd be thrilled if I went ahead and did all of the work for you in fixing the system I'd be more interested in getting it done in this lifetime and working together. It doesn't matter anymore to me though. I've never really wanted to be part of this community and I have had enough trouble dealing with the transgender community as it is. I just want to go stealth and move the hell on with my life instead of sitting around with a bunch of people who are content with settling for being treated like garbage. I have too much self respect for that.

[Jean24]

Meh. It is what it is. Sure, I still remember how annoying that 8-month long wait for my HRT letter was. But, it was worth it in the end. It's just the way that it goes.

That doesn't make any part of what they're doing to us acceptable.

[V]

You sure have had some bad experiences with therapists.
My therapist was probably the one person in my whole transition who helped me the most. He certainly saved my life. He gave me the legitimacy I needed to go out and face the world as who I really was. Rather than having me sectioned and thrown in the loony bin, like previous doctors had done.
He helped my parents understand me.
He was a legend.

Unfortunately therapists are needed because there are people for whom transitioning away from their assigned at birth gender is not the right thing to do. The kind of people who demand surgery, hrt, et al, and then afterwards decide it was all a big mistake. Y'know, the people who do us genuine trans folk no good at all, they are often the ones that get featured in the media.
As far as I know, there are no testable, physical symptoms that can be checked to easily and accurately verify that one is trans. Correct me if I'm wrong here. So some king of talking therapy is really the only way that the medical profession has, to both make a judgement, and to cover their own backs. If everyone was 100% genuine and accurately self-diagnosed themselves, then maybe we wouldn't need therapists, but alas this is not the case. Whether or not it's fair is a moot point. Life is rarely fair anyway.

Also, lying to therapists to get a certain diagnosis sounds like a bad idea, maybe that's why you've had such a hard time with them?

[becky.rw]

I'm really not trying to be abrasive or really even argumentative.   But two things...

First off, you talk about something that is as important to you as changing your body to match your gender, and you allow the insurance company to decide whether you fill a script or not?   Seriously?   If you have the script, you fill it, period. If the insurance pays, great; if they don't, that's fine too.  If you think the insurance company should have paid, file a claim direct afterwards.    Regardless, the pharmacy does not care who pays.     Get the script.  Fill it.  Pay the clerk.  Forget the insurance company.

Second thing,  IC and hole in the wall.   What do you expect in a model that doesn't have all that much patient contact?   Do you think some grand wizard just forwards them a check for $150k a month for rent, power, lights, liability, whatever?   Best obgyn I ever met worked out of a rathole in a run down building, lots of patients, everyone in the waiting room sitting on decades old lunchroom chairs.   The rathole did not impact quality of care.

I still can't get past the insurance thing though?  Really??

I've paid thousands in retail for meds not covered by insurance, thousands.    I drive a crappy, 20yr old truck, and my family is healthy(ish) and well cared for, despite our health issues.   E & tblockers don't cost beans.

[Laura_Squirrel]

If therapy worked for you. That's great. For me personally, 18 sessions of talking to someone about how I don't feel like a man and internally feel female got old quick. I could see a having to sit down for a session or 2 just to make sure you have your stuff together.

I had 8 once a month sessions since that was all that I could afford.

[Jean24]

You sure have had some bad experiences with therapists.
My therapist was probably the one person in my whole transition who helped me the most. He certainly saved my life. He gave me the legitimacy I needed to go out and face the world as who I really was. Rather than having me sectioned and thrown in the loony bin, like previous doctors had done.
He helped my parents understand me.
He was a legend.

Unfortunately therapists are needed because there are people for whom transitioning away from their assigned at birth gender is not the right thing to do. The kind of people who demand surgery, hrt, et al, and then afterwards decide it was all a big mistake. Y'know, the people who do us genuine trans folk no good at all, they are often the ones that get featured in the media.
As far as I know, there are no testable, physical symptoms that can be checked to easily and accurately verify that one is trans. Correct me if I'm wrong here. So some king of talking therapy is really the only way that the medical profession has, to both make a judgement, and to cover their own backs. If everyone was 100% genuine and accurately self-diagnosed themselves, then maybe we wouldn't need therapists, but alas this is not the case. Whether or not it's fair is a moot point. Life is rarely fair anyway.

Also, lying to therapists to get a certain diagnosis sounds like a bad idea, maybe that's why you've had such a hard time with them?

Let me first say that I'm glad your therapist saved your life and that your experience has been excellent.

However, therapists do not cover the backs of doctors because being transgender isn't something that is psychological. Most if not all of being transgender is physical which is why going to a therapist in the first place (for being transgender) is pointless. A therapist isn't even capable of helping you with your medical decisions unless they are given all of the keys - that is supposed to be between you and your doctors.

And this entire vetting process can be done without them. HRT is so incredibly slow that an appointment with your doctor every month in the beginning would suffice. They can advise you to stop if you become dysphoric from your new developments, your therapist can advise you to tell your doctor about growing dysphoria with HRT. It's just a middle man. And again if this is based on your word that you are transgender it should be good enough for your doctor. And there are SO many tests a doctor can do for people. For MtF they can have brain scans, digit ratios, test your AR gene, sperm production and motility levels, etc. With FtM have correlations as well, such as PCOS and hormonal markers.

I feel like lying to my doctors is a great idea. I WILL NOT let them hold my medical well being hostage because they think I'm depressed, or send me to the hospital for feeling the way I always do when that spmply never helps. I want to get the most out of HRT while I'm still young enough to get results and waiting 6 months and starting over with a new therapist once more isn't an option.

I would do it again and I would strongly suggest everyone else do it because your medical health is between your and your doctor.

[becky.rw]

This story is getting weird;  you got sent to the hospital for a mental health, gender/sex(depression) related, are willing to lie at will, but did not walk out of the hospital with a depo anti-androgen?

I don't think you actually lie or want to lie and are just frustrated with a bad sequence of events, a sequence the docs really can't do much about because you keep trying to instruct them on how to do their job.  They have very specific things they can and can not do; if they do a "can not do"; they'll lose their livelihood, their home, their family, EVERYTHING.

[Jean24]

I'm really not trying to be abrasive or really even argumentative.   But two things...

First off, you talk about something that is as important to you as changing your body to match your gender, and you allow the insurance company to decide whether you fill a script or not?   Seriously?   If you have the script, you fill it, period. If the insurance pays, great; if they don't, that's fine too.  If you think the insurance company should have paid, file a claim direct afterwards.    Regardless, the pharmacy does not care who pays.     Get the script.  Fill it.  Pay the clerk.  Forget the insurance company.

Second thing,  IC and hole in the wall.   What do you expect in a model that doesn't have all that much patient contact?   Do you think some grand wizard just forwards them a check for $150k a month for rent, power, lights, liability, whatever?   Best obgyn I ever met worked out of a rathole in a run down building, lots of patients, everyone in the waiting room sitting on decades old lunchroom chairs.   The rathole did not impact quality of care.

I still can't get past the insurance thing though?  Really??

I've paid thousands in retail for meds not covered by insurance, thousands.    I drive a crappy, 20yr old truck, and my family is healthy(ish) and well cared for, despite our health issues.   E & tblockers don't cost beans.

I think you missed the part where I said that I could not afford to do that.

Some people can fire their therapist and buy their own stuff and say the hell with all of this. I can't, and it is a form of discrimination based on class.

And they are expensive out here. Lupron is $1100 for one injection uninsured. I found it over the counter for about $160 and I had a few but I still couldn't afford that - 160/month comes out to $1900+ per year. Spiro is about $60 a month. E, Progesterone, and Finesteride are all about $20 a month. That's thousands a year for medicine which other people would have covered because their affliction is different. Maybe they have prostate cancer, balding, high blood pressure, low estrogen, have a small bust, etc. If you're cis you get this stuff covered right off of the bat. It even applies to the surgeries which cost tens of thousands of dollars. Facial, vocal, and genital reconstruction? They pay for that all day and all the patient has to worry about is a relatively small deductible, not if the insurance company will foot them the entire bill.

[V]

Gender dysphoria is a very specialised area of treatment for medical professionals. My GP had no experience or knowledge of it at all. He needed the backing of a trained professional gender therapist to be able to prescribe me the meds I needed. I don't find this AT ALL an unreasonable demand.
Also, surgeons carrying out srs operations need the backup of trained professional gender therapists, so they can be (somewhat) sure that this person who they don't have the time to see regularly over months, really is the right recipient for such serious and life-changing surgery. The surgeons don't want to be sued by patients who later decide their surgery was a mistake.
What about the person who 'fails' all those so-called physical tests you listed? Should they be turned away as "not trans"?
I'm sure I'd fail a few of them!
I'm not rich, I went private (here in the UK) and self-funded all my treatment. I just had to save up for something I knew I really needed.

[Jean24]

This story is getting weird;  you got sent to the hospital for a mental health, gender/sex(depression) related, are willing to lie at will, but did not walk out of the hospital with a depo anti-androgen?

I don't think you actually lie or want to lie and are just frustrated with a bad sequence of events, a sequence the docs really can't do much about because you keep trying to instruct them on how to do their job.  They have very specific things they can and can not do; if they do a "can not do"; they'll lose their livelihood, their home, their family, EVERYTHING.

That's actually happened twice and I walked out of the hospital both times without a depo anti-androgen from 2 different hospitals. The most the did was suggest anti depressants and and anti psychotic 6 months later when they found out the depressants weren't worth anything. That all resulted from me telling my therapists the truth about my feelings. That's why I don't share them anymore and lie when I'm asked. They're interested in everything but the problem.

I didn't really understand that second part about docs and what they can do. This has almost nothing to do with them and everything to do with therapists. I don't have problem going to them for mental problems but as you and everyone else here knows, being transgender isn't one of them. Personally I think that's why they don't really do anything concerning it. No therapist that I have ever seen has asked me how dysphoric I was that day. Not one. They care about mood and having control over the tempo of the medical process.

[LauraE]

I found therapy to be handy. Not because I was mentally ill, my psychiatrist was always quite clear that my mental health was good. Why did I find it handy then? To offload parts of my past that I had no desire to carry around any more. To help deal with the parts of transition I was mentally unprepared for.

Agreed. Having an objective observer, someone who can both validate you as well as probe, can be a very useful thing. I'm on Kaiser, so i'll have to meet their gatekeeper. In the meantime, i'm working with a very nice therapist who doesn't judge me and who is helping me on my journey.

Which is they way things should be.

Laura