Standards of Care

[LaurenS.]

I was reading Anne Lawrence's info on her website and she was talking about many patients that had SRS without completing a year of RLE. Many without doing it at all. I'm confused as I thought surgeons had to abide by the HBIGDA Standards of Care. Am I wrong? Can one have SRS at any time?
Lauren:daydreaming:

[carolinoakland]

I think that if you go to thailand they don't follow the soc. if you can pay the frieght... not the way I would do it, I figure there's a reason for these things. And I for one question every surety I believe I have about my choice. I figure the time to question a choice is BEFORE it's irreversable. but that's just me. I figure I've waited so long than to do it any other way than correctly, safely, and right. Carol

[MichelleBolton]

I am sure there are Surgeons out there that will do things without following the standards of care.

But don't you think that it is important to follow the standards of care, in fact, isn't it important, that we go above and beyond the standard of care to ensure a successful transition?

I am sure we all have our moments where we wish it done, now, and wake up in the morning in the right gender, the right body. Yet, I have put much thought to this. So, I wake up in the morning, in the right body - yet nothing else has changed. Well, I would have a hard time in every day life.

I think the standards of care are important. I personally am questioning everything about transition, and slowly moving towards myself.

Each of us have our own journeys, but for me, I am glad that the standards of care are there, as they create a baseline for which I can transition.

For me, I proceed with care, slowly, surely. I hope because I proceed in this way, that I experience the journey along the way, and I appreciate where I end up, also knowing that when I get there, the journey of womanhood has truly begun, which in it's self is another journey.

I see on these sites people who self medicate, and bypass the standards of care. I suppose it is their choice to do, but when I think about it, are the standards of care all that hard?

I don't think so, for me, I have known from 6 or 7 years old that I am TG, yet, I buried it until about 6 years ago. Now, I am working on myself, moving forward slowly each day. I want to make sure, be 100%, no turning back.

SRS for me is really not the end goal. The end goal is living the life of the woman I am, and SRS is a step along the way.

At one point, a long time ago, I thought having my body correct was the end all be all, but now, I understand that being a woman, is not defined by what is better my legs. I am a woman. I have always been a woman.

So, for me it's about aligning my body to my mind, and if there are standards of care, I welcome them.

I am sorry if I sound like I am going off, but I tend to read on these boards more than I respond. So many seem to want to bypass the standards of care, or self medicate.

Heck, I understand the drive, and the need. There is no question, but to me it's about bringing sense to the process, and allowing it to take a good natural course with checks and balances.

Hugs, Michelle.

[Tizabet]

isn't it important, that we go above and beyond the standard of care to ensure a successful transition?
Indeed, it's important to do what's right for each of us. Too bad humans aren't as standardized as the SOC would like. ;) I see it as guidelines, not concrete rules or facts. It's definitely worth paying attention to, but I won't put my fate in the hands of a piece of paper who's never even met me, either.

[joanne2b]

How many of us have wanted to miraculously wake one morning and find that we are a girl/woman, should that happen would you embrace it or start thinking mmm, don't know about this. How many questions do you have to ask yourself, if you continue to ask the same question of yourself then there is doubt, if there is doubt then leave it out. One can discuss the issue with as many shrinks or other health care persons as you like but at the end of the day you are the only one know's your own mind and true feelings. By all means stick to the 12month rule or any other if it suits you but by pontificating about it things will not change, you will still have the same thoughts and desires. If there is any doubt in your mind after having been aware from chidhood that you would like to have been a girl then just continue with dressing as a female do not go for SRS. However if you are quite sure and accept that it really is life changing forever then book a trip to Thailand or wherever and wake up that one morning when the miracle has happened and enjoy life, me, soon as possible wasted too much time already.. :hugs:

[GypsyKaren]

Many of the Thai surgeons aren't as strict about the standards, I know that mine wasn't, but I still followed them to the letter. It is a personal decision and I myself didn't see the need to do it, but I did anyway because I could.

Karen :g2:

[LaurenS.]

Thankyou all for your responses. I personally think the SOC are good rules to follow. After reading Anne Lawrence's website info it appeared that the SOC need not be followed. I think they are important but as some have said...when you've been longing to be a woman for as long as you can remember...do we have to endure another year? As with most subjects, it can be debated. I understand the reason for the SOC and know that for many they are necessary. I will abide by them as it appears I have no choice as I don't care to go overseas. Maybe if I were 25 years old the wait wouldn't bother me. Also, somehow I just don't feel comfortable trying to live a Real Life Experience and still be legally a male. I'm not trying to argue with anyone. I know all too well how important it is to have rules in place. I guess sometimes following the rules can be frustrating.
Lauren

[tori-e]

Although you know in your heart you are a woman, the SOC is there to make sure that you can actually live your life as a woman. As you go through that year before surgery you will find that your mindset, self esteem and who you see yourself as, will change. The actual 365 days is somewhat arbitrary, but gives the doctors some reason to believe that this is the right thing for you to do.

It is smart for the doctors to follow the standards as there is less chance they’ll get sued. That said I know a transwoman that paid an extra $1000 for breast augmentation to side step the SOC.

Dr. Brassard requires two letters from professionals stating you’ve met the requirements. Overall, it’s the right thing to do.

Terri

[Sarah...]

The updated DoH guidance for GPs in the UK does indeed expect a process to be followed that involves RLE BUT the guidance is quite clear that the trans person is the person in charge of their transition and that there is no absolute standard with people transitioning at different rates depending on their unique situations.

So some people will complete the process way faster than others.

Me? I'll be happy to complete at my own speed, whatever that is :)

Sarah...

[Kimberley]

MOST SRS surgeons do follow the HBSOC. Of course you can always buy a Rolex on the corner for $25. Personally, I wouldnt go near a surgeon who didnt follow the SOC.

They are designed to protect both the surgeon and the patient. They are not rules for us but rather guidelines for treatment protocols by the physicians. We are or should be fully aware of them though. So, if you want to go to a doc who subverts the guidelines or ignores them, then it is your choice. It is also your risk. You need to ask why the doctor doesnt see them as necessary.

:hugs:
Kimberley

[Chloe84]

Lets not forget that the SRS is not going to make you a woman over night, it might in one way, but it will not fix everything in a click of a button. My therapist is big on the Idea of not just transitioning your Physical apperance, but also transitioning your mind, and and spirit.

all too manny trans women want to rush the process as if SRS is the goal, but in all reality isn't being accepted as a woman, and living as a woman the Final goal.

and think of all the good things that you can get done to prep yourself in a year. Voice training, Electrolysis, develop a sense of personal style. lean the basics of female mannerisms, and the list goes on and on.

So is a year too short of a period of time to live full time, i think not, maybee it is for some, but i also think that for some its not enough, but thats just my $0.02

[MJ]

the question is what if someone rushed in to srs and a few months later realized they made a big mistake..
and they are out there too . i have completed the RLT and it is not as easy as some think. i needed the time for my adjustment.

[Melinda]

The standards of care aren't a law, just medical guidelines. If you've got the money there are surgeons who will do anything you want them to.

Just like the guidelines about implanting a mother of 6 with 8 embryos. Not that I don't feel for that girl. She and her kids need help and not endless criticism. No amount of yelling at her now is going to put those embryos back in the freezer.

[Nicki B]

I'm confused as I thought surgeons had to abide by the HBIGDA Standards of Care. Am I wrong? Can one have SRS at any time?

If you know where to go and have the money, yes.. But would you be wise?

[Raquel June]

I know people don't tend to agree with me around here on this topic, but I don't like the HB standards. They try to stuff everybody into a single category. While they are a well-meaning set of guidelines for people who have no idea how to treat TS patients, for some people they do more harm than good. TS people already have social problems and giving them a bunch of rules they have to follow -- rules that by their own admission can't apply to every TS person -- just isn't right.

On the surface it makes sense to say a M2F shouldn't get SRS without knowing they can handle living as a female, but but how exactly do you even define "living as a female" except by demanding compliance with vague gender roles which really have nothing to do with whether or not someone should get SRS? There are plenty females out there for whome "living as a female" means a T-shirt and jeans and comfortable shoes. By at least some definition, our entire lives have been the "real life experience."

And that's the problem -- all the vagueness around what the guidelines actually mean.

If people would legitimately pay attention to the standards, I don't really see much problem in them. At least in the most recent version, there is simply the requirement of a real-life experience or 3 months of therapy before getting on HRT, and if someone is already taking HRT the standards allow for them to be given HRT under doctor supervision without having to jump through any hoops. I think that's all great, and I've never met a TS persion who couldn't use at least three months of therapy. Actually, I don't need to qualify that; I've never met any person who couldn't use at least three months of therapy. I probably would've killed myself if I hadn't put myself in therapy a few years ago.

But there's a problem with telling people they need therapy, too. Many people would argue that three months of therapy is barely going to scratch the surface for anybody with serious issues. If someone is just trying to get on HRT and doesn't really want therapy, they're going to get absolutely nothing out of it. So all they get is another hoop to jump through and a 3-month cooling off period.

Then of course there's the fact that if the doctor tells them to do something they don't want to do, they're probably just going to order their hormones online.

And when it comes to SRS, they say you should be on HRT for a year and have a year of "real life experience." But again, what does that even mean? Some women have facial hair. Some women have short hair. Many women wear pants. And I know women with wide feet who buy almost all their shoes in the men's section. Ever noticed how bent of out shape the GGs get when someone says a CD looks more feminine than a GG? Because being female doesn't really have much to do with prancing around in frilly panties. So what exactly defines the real life experience? It sounds good until you try to put some specifics on paper, then it's just ridiculous.

Legally changing your name is a pretty concrete thing that's probably a reasonable requirement, but I actually know several women with my first name.

So, in spirit I do agree with the Harry Benjamin standards. I think people should have therapy before going on HRT, and I think people should be on HRT for a year before SRS. I just don't think it's reasonable to tell people that's the way it has to be done.

The ICTLEP standards are much more realistic. The important differences being:






Principle 5. It is unethical to discriminate in the provision of sex reassignment services based on the sexual orientation, marital status, or physical appearance of a patient.

Standard 1. Physicians participating in transsexual health care shall provide hormonal sex reassignment therapy to patients requesting a change in their sexual appearance subject only to (1) the physician's reasonable belief that the therapy will not aggravate a patient's health conditions, (2) the patient's compliance with periodic blood chemistry checks to ensure a continued healthy condition, and (3) patient's signature of an informed consent and waiver of liability form. If the patient is married, the physician may not require divorce but may also require the spouse to sign a waiver of liability form.

Standard 3. Surgeons participating in transsexual health care shall provide sex reassignment surgery to patients requesting a change in their sexual appearance subject only to (1) the surgeon's reasonable belief that the surgery will not aggravate pre-existing health conditions. (2) the surgeon's reasonable determination that the patient has been under hormonal sex reassignment therapy for at least one year, and (3) the patient's signature of an informed consent and waiver of liability form. If the patient is married, the surgeon may not require divorce but may also require the spouse to sign a waiver of liability form.


But even that's kind up in the air. There are probably plenty TS people out there who feel very comfortable in their chosen gender without medication, so why tell them they have to take meds for a year before they can get SRS? There's actually a M2F in my support group who has never taken any kinds of meds and has a natrual C-cup (and I'm not talking about a fat person who can fit into a bra). Are you going to tell her she needs estrogen for a year if she doesn't want it?

[~Kelly~]

Racquel, that was one of the best responses to this question that I have read in a long time. I agree with much of what you say, however there is a problem with abolishing the standards altogether. I have been a supporter of the standards of care and will continue to support them merely in the fact that it does have the effect of "weeding out" those who aren't really serious. Before any one goes off on that comment, allow me to explain it. Even on this forum, there seems to be a fascination amongst many to alter ones body but "only this part, but I want to keep that, and I am not planning on transitioning, I just want __________" When encountered in discussion, there is rarely any actual thought or research done on the logistics of accomplishing this, but rather it seems more like a fantasy. I am not saying that this is necessarily wrong. I went to bed every night praying that I would wake up with the right body just like MANY others did. But if the Standards of Care were lifted and there was nothing standing in the way between Joe Crossdresser and SRS, I think there would be a LOT more people who would go that route without thoroughly thinking it through and regretting their decision. And maybe my reasoning is a bit selfish, but how does this affect me? Well lets just say the "satisfaction" rate of SRS goes from 99% down to 85%. Suddenly, transitioning doesn't appear to be a "guarantee for happiness" (not that I consider it that.......just using it as an example). Now there is doubt in the mind of the public as to the efficacy of transitioning when dealing with gender issues. "Surely there is something else that can be done.........look at all the people who go get the surgery and regret it!" Yes, I know that is already an argument now, but what those who use it don't realize is how extraordinarily SMALL the percentage of who they are referring to really is. Once that percentage starts to increase, doubt will be spread to the public (more so than it already is). But on the other hand, this is a hypothetical situation and may very well NOT occur. Those who could be helped by dropping the Standards of Care could very well overshadow any that slipped through the cracks and therefore give an even more positive view of trans-people. I really don't know the answers. I can only suppose. And I suppose that there is merit to "jumping through a few hoops" if it means that our situation can have at least some air of legitimacy to the general public.

[Raquel June]

I've talked to a few people who were less than satisfied with their SRS, and it was never an issue of them rushing into it and regretting the decision. It was about them thinking SRS was a magical cure for all their problems. It's a major surgery and absolutely nothing to be taken lightly, but in the end all you're doing is rearranging the most hidden part of your anatomy, so it's not going to be a night-and-day difference in your life.




And I suppose that there is merit to "jumping through a few hoops" if it means that our situation can have at least some air of legitimacy to the general public.

Well I can't disagree with that. And I don't want to speculate too much about what would happen if nobody followed the HB standards. But more of the people I've talked to have gotten SRS in Thailand than have in the US, so if it was going to be a problem I think it already would be.

Being TS certainly doesn't make life easy. I would guess that if someone was prone to making major bad decisions they probably would've already rushed into suicide or at least shooting heroin.

[GypsyKaren]

You can go anywhere and get all of the plastic surgery you could ever desire, you can get your face and body completely changed and rearranged to the point where your own mother would never recognize you, you can get so many surgeries that your face will be in danger of falling off, and the only requirement to do all this is having enough room on your credit card. There are no standards, no commissions, no overlords, not one single ounce of "you have to do this first in order to be considered." You want SRS? I'm waiting for the powers that be to form an interplanetary task force on the off chance some surgeon wants to build a clinic on Mars.

Everyone thinks that if anyone could do it, there would be millions who would be making a big mistake and ruining their lives because they wouldn't know what they were getting into, but I disagree. I'm sure there would be some, but to tell you the truth, I could care less. If someone wants to jump off a building, have at it, just don't land on my car. Why should someone who is sure and is desperate have to jump through hoops in order to protect some idiot with a credit card? The thing is, you take all of these people who are foaming at the bit for SRS when they don't have a clue or rhyme or reason, and watch what happens when the realization sinks in that it actually involves cutting off their penis, and you'll see a stampede for the exits like you wouldn't believe...nothing bursts a bubble like penis chopping time.

Karen :g2:

[Raquel June]

nothing bursts a bubble like penis chopping time.

Inspired.

[Karen564]

watch what happens when the realization sinks in that it actually involves cutting off their penis, and you'll see a stampede for the exits like you wouldn't believe...nothing bursts a bubble like penis chopping time.
Karen :g2:

That's so true,
This is what separates the men living in fantasy land from the REAL Women..


As much as I see many good points of the HB SOC, I also see just as many flaws in it too. But nothing is perfect in this world anyways.

Karen

[Rayne1]

Everyone must decide for themselves whether they want to follow the guidelines or do SRS earlier. The reason they set up these guideline is that transition is an expensive process and once you have gone through these steps and do the final thing of having the SRS you are not going to change your mind. If you are certain that you are transsexual and not just cross dressing and have experienced what the world has to give you and are willing to go the distance with all the sacrifices you will have to make then I think is the time you can consider SRS. That is why one of the guidelines is having a therapist go over all these issues with you. The younger the person is in transition the better. I know there is an age limit for surgery for those who are older because of health risks.
You are the only one who can decide if you are ready, because no one else really knows you, but you. You can receive all kinds of advice from others who may have similar experiences you will face, but not every life is the same entirely. Just be you and don't jump before you are ready.

[tamarav]

I have three TS friends who all went to Dr. Preecha in Thailand for their surgery. Two of them went directly over without any hint of a year of living as a woman, since both felt that they had been living as a woman their entire life. Both seem to be doing well and have retained their jobs with the same companies that they started with. There was always na ambiguity about their gender anyway, so their interpretation may have been correct.

The third friend, who did almost 2 years in her living as a woman, has not done as well as the other two. She was always a bit more hesitant about presenting as a woman and as such may not have taken the appropriate path. She is still having some difficulty adjusting to being a woman after 4 years.

I have always questioned the appropriateness of this "requirement" for all people since there are such different interpretations of what being a woman actually is.

My best to all of you.

[Rifkinn]

I know personally that, with my therapists blessings, I am not going to be taking the "standard" route and she said she has no problem with backing me up all the way if anyone questions me on it. :^)