Real life experience
Real life experience (RLE), sometimes called real life test (RLT), is a process where transsexual and transgender people live in their preferred gender role for a designated length of time (usually 12-24 months), in order to demonstrate that they can do so; and to gain permission for gender reassignment surgery.
A minimum requirement of 12 months RLE is part of the World Professional Association for Transgender Health Standards of Care. In many places this differs - for example in the United Kingdom most National Health Service trusts will require 24 months, although this has recently changed in Scotland so that it is easier for trans people to start hormone therapy after a Gender Identity Clinic referral (or self-referral) and cutting the time until surgery to 12 months to match version 7 of the SOC.
In Thailand, a variant of the SOC was implemented in late 2009 to address quality of care by requiring surgeons who perform genital surgery to register with the Medical Council, check for and give treatment for any post-operative complications, and require two letters of recommendation by mental health professionals before surgery can happen.
Real life experience is usually considered to start after transitioning to full-time. In the UK and the Canadian Centre for Addiction and Mental Health (CAMH), this RLE is considered to start from the date of legal name change.
The intention of requiring RLE is to reduce the incidence of post-operative regret by giving people more time to come to grips with and reflect upon what exactly they are doing and also to ensure that their plan to transition is in fact what they desire.
The RLE period can be dangerous for trans people, since the person must live in their target gender with no supporting documentation, running the risk of discovery. Many transgendered people have suffered assault, murder, fatal denial of care, or other human rights abuses after the mismatch between their gender presentation and their genitals and documentation have become apparent.
Some trans people have Facial feminization surgery at the start of their RLE. This can help them pass more easily and help co-workers see a visual change to go with the gender change. However, FFS is not reversible and has potential complications. A period of Hormone Replacement Therapy in advance of the RLE is often advised to assist the trans person with "passing" as their target gender.
In evaluating the quality of RLE, clinicians will use the criteria listed in the Standards of Care.
Critical items in this list include the ability to be employed or function as a student or a community-service volunteer. A person who cannot perform at least one of these functions can be considered socially impaired. Difficulties functioning in society is a contraindication that the person can live successfully full-time. On the other hand, therapists ought to take social prejudice and cultural mores into account when the person is unable to find work in their target gender.
Many clinicians consider a legal name change to be a critical indicator of a true RLE. This is not to say that when legal authorities deny a name change, the RLE would be invalidated. Clinicians should take social prejudice into account when determining whether a legal change is needed. Nevertheless, some therapists count the legal name change as the marker indicating the start of RLE.
An important criterion is to demonstrate that there are those other than the therapist who know that the person is living in the desired gender role. Being "full-time in your head" is not acceptable for RLE. Driver's license, passport, credit cards, and personal correspondence in ones preferred name are forms of evidence for this. Many therapists will also observe how the person is dressed when attending therapy sessions or for other appointments.
Additionally, clinicians may look for signs of co-morbid conditions, other problems that may mask whether the person can be successful in their preferred gender. Because of this, there is a level of therapy expected to be achieved in order to assess results. When co-morbid conditions are evident, RLE may be extended until those conditions are resolved in some manner.
In some cases, clinicians may use additional criteria not included in the Standards of Care. An example would be whether a person uses the proper restroom when out in public. The therapist should list what criteria they will use in assessing the quality of the RLE.
- Hormone replacement therapy (male-to-female)
- Hormone replacement therapy (female-to-male)
- Facial feminization surgery
- Gender reassignment surgery (male-to-female)
- Gender reassignment surgery (female-to-male)
- Sex/gender reassignment therapy
- Real life test/experience issues and how to cope with them
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