New Version of Standards of Care

[Beth-Lock]

I have just learned that there is a new version of the standards of care out just now, which represents a greater degree of flexibility and some more liberal versions of various requirements. For example, it may not be necessary in some cases to have hormone therapy before gender correction surgery now. These are however exceptions to the rule. The requirements for a real life experience living as a woman, (the RLE), have also apaprently been liberalized.

These changes may give renewed hope to some TS folk, and certainly do for me.

[Rianna Humble]

After clarification, it seems that I had misinterpreted what Beth was trying to say, for which I apologise.

I welcome the new SOC (http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf) because of the shift in emphasis from what we must do to merit the treatment that we need to how health professionals should treat our health needs as a whole.

The RLE was not a requirement prior to Hormone Therapy in the previous version of the Standards of Care and still is not.

However, in the Summary of Criteria for Hormone Therapy and Surgeries they still include for vaginoplasty
12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones);

12 continuous months of living in a gender role that is congruent with their gender identity.

They go on to say
The criterion noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity – is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery.

[Katesback]

There is no standards of care written for a woman. They are written to address the care of a trans person. Since I knew I was a woman I ignorred the standards of care. Never went to a therapist and did it my way because I did not need to pay people to tell me things I already knew.

To each their own but the standards of care meant nothing to me in my journey.

[Melody Moore]

Kate,

you are not the only woman here and just because you didn't follow the Standards of Care, those
of us who are going through our transition through a gender clinic ran under our public health system
have no choice but to adhere to the Standards of Care. I don't know how you got approval for SRS
without following them. So it sounds to me like someone told a few tall stories somewhere to get
approved for SRS. Personally I would rather follow the SoC than to do something stupid which may
jeopardise my whole transition and put my health at risk. So I think Kate some of your advice is very
dangerous and very misleading. Anyway, I am not here to talk about your path, I am here to talk about
the paths that others must follow.

The thing that I liked about the new Standards of Care is that they are more inclusive and highlight
the need that other gender variants also suffer from similar issues to transsexuals and that some of
the treatments may be used to help them as well. This has angered those who followed the original
Harry Benjamin Standards of Care & those people who believe that it should support only those with
transsexualism, and who are really offended now because 'gender non-conforming people' who might
have 'Transvestic Fetishism' are now managed under the same set of guidelines for gender disorders.

I had a run in a few days ago with Charlotte Goiar (http://www.shb-info.org/goiar.html) on Facebook over this after she added me to her group
and posted a link to the new site I am setting up for our support group which also follows the WPATH SoC.

After she posted a link to my site, there discussion was taking place about the site and the new WPATH SoC
which obviously will play a huge part in how I structure the new site and about what information I publish on it.
There was some debate starting to allude to the site's definitions of the gender variants, but it was explained that
it is only a new site & that content was still being drafted up to be added that used the same terminologies as
are outlined in the new SoC. But when I pointed out why 'inclusion' was so important to our group my comments
got a lot of support from other group members, but I got kicked from the group after I made the comment. So I
contacted Charlotte to enquire as why she did that and here is the response...


We don't feel that the WPATH speak for us nor represent us regarding HBS because we consider
it to be a very serious medical condition instead of a "gender non-conforming" state of mind. The first comment that Charlotte Goiar (http://www.shb-info.org/goiar.html) makes proves that she is taking offence to terms like "gender non conforming".
Charlotte has obviously taken offence because transsexuals have been put in the same group as these other gender
types and that our needs should always remain exclusive of everyone else's is the feeling I get here. But the truth is
many gender variants are affected by Gender Dysphoria which is a mood condition that relates to gender identity issues
and this is how it has now been outlined in the new WPATH SoC. Gender Identity Disorder (GID) is a totally different
condition to Gender Dysphoria (GD), however GD can affect those who are diagnosed with GID, but GD can also affect
all other gender non-conforming (GNC) people.

Charlotte graciously "invited me to re-join again after there is more clear differentiation of the different conditions"
on my site. But I told her not to bother - my whole opinion of that woman has been changed in the blink of an eye
after her very crazy response to these new Standards of Care. :heehee:

[JennyA]

There is no standards of care written for a woman. They are written to address the care of a trans person. Since I knew I was a woman I ignorred the standards of care. Never went to a therapist and did it my way because I did not need to pay people to tell me things I already knew.

To each their own but the standards of care meant nothing to me in my journey.

EXACTLY! thats how i am doing things

[Melody Moore]

Irrespective of the fact that you know you are a woman - in most places you have no choice
but to follow the SoC because they have been adopted my health services around the world.

While I no longer am affected by GD, I have been affected by it in the past, but
I know I am a woman already as well - but does that make me "Super-Woman?"

If you like taking huge risks and gambling with your own life, that's fine, but do not think
that your path is the right path when it is flawed with so many possible pitfalls - there is
no substitute for proper professional help for gender transition. And I think it is extremely
irresponsible for us to promote or to tell others not to follow the WPATH Standards of Care
regardless of what anyone says.

[Kaitlyn Michele]

Real women don't brag about how they know everything, know how to do everything, and know better than every one else.. we just don't


just sayin...

[ameliabee]

One of the nice changes, at least for those starting transition, is that SOC v7 requires only a referral from a psychologist to start HRT, versus a referral and three months of counseling/psychotherapy, three months of real life experience, or for one to have been self-medicating prior as required by SOC v6.

[Katesback]

Melody. I did not offer any advice. I offered my opinion on the standards of care.








Kate,

you are not the only woman here and just because you didn't follow the Standards of Care, those
of us who are going through our transition through a gender clinic ran under our public health system
have no choice but to adhere to the Standards of Care. I don't know how you got approval for SRS
without following them. So it sounds to me like someone told a few tall stories somewhere to get
approved for SRS. Personally I would rather follow the SoC than to do something stupid which may
jeopardise my whole transition and put my health at risk. So I think Kate some of your advice is very
dangerous and very misleading. Anyway, I am not here to talk about your path, I am here to talk about
the paths that others must follow.

The thing that I liked about the new Standards of Care is that they are more inclusive and highlight
the need that other gender variants also suffer from similar issues to transsexuals and that some of
the treatments may be used to help them as well. This has angered those who followed the original
Harry Benjamin Standards of Care & those people who believe that it should support only those with
transsexualism, and who are really offended now because 'gender non-conforming people' who might
have 'Transvestic Fetishism' are now managed under the same set of guidelines for gender disorders.

I had a run in a few days ago with Charlotte Goiar (http://www.shb-info.org/goiar.html) on Facebook over this after she added me to her group
and posted a link to the new site I am setting up for our support group which also follows the WPATH SoC.

After she posted a link to my site, there discussion was taking place about the site and the new WPATH SoC
which obviously will play a huge part in how I structure the new site and about what information I publish on it.
There was some debate starting to allude to the site's definitions of the gender variants, but it was explained that
it is only a new site & that content was still being drafted up to be added that used the same terminologies as
are outlined in the new SoC. But when I pointed out why 'inclusion' was so important to our group my comments
got a lot of support from other group members, but I got kicked from the group after I made the comment. So I
contacted Charlotte to enquire as why she did that and here is the response...

The first comment that Charlotte Goiar (http://www.shb-info.org/goiar.html) makes proves that she is taking offence to terms like "gender non conforming".
Charlotte has obviously taken offence because transsexuals have been put in the same group as these other gender
types and that our needs should always remain exclusive of everyone else's is the feeling I get here. But the truth is
many gender variants are affected by Gender Dysphoria which is a mood condition that relates to gender identity issues
and this is how it has now been outlined in the new WPATH SoC. Gender Identity Disorder (GID) is a totally different
condition to Gender Dysphoria (GD), however GD can affect those who are diagnosed with GID, but GD can also affect
all other gender non-conforming (GNC) people.

Charlotte graciously "invited me to re-join again after there is more clear differentiation of the different conditions"
on my site. But I told her not to bother - my whole opinion of that woman has been changed in the blink of an eye
after her very crazy response to these new Standards of Care. :heehee:

[Frances]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

[Aprilrain]

I was and still am happy to follow the standards of care. WHY NOT? it takes years for HRT to work anyway and as Frances pointed out SRS is just the icing on the cake of a full and complete GENDER transition (not a sex transition). That being said the HBSoC are not law (at least not in the USA) and people are free to do with their bodies as they wish

I think it is great that the health care profession is recognizing what it has been teach for a while now. If gender identity is a "spectrum" then it makes sense that their would be people who have gender issues who may not want or need to transition fully but still require some type of care.

[Traci Elizabeth]

I also agree with alining oneself with the standards of care. I have always been a woman and did not need anyone else confirming what I already knew. Nevertheless, I volunteered to follow the SOC. Having a psychologist and MD help you through your transition can only be beneficial not harmful.

There are far too many of us who change our minds either before or after SRS to gamble the odds. So it makes sense to me that RLE and the rest of the SOC can only be helpful in you finding out if this is the road you truly want to follow.

Its one thing to know within you that you are a woman in a man's physical body. It is an entirely different act to commit yourself to permanently live that other gender legally, physically, chemically, and emotionally thus the SOC.

[Melody Moore]

April, while the SoC is not law anywhere medical services and support organisations like Queensland Health, our state
government funded public health service runs our Sexual Health Service here have adopted the SoC as their policies
so it might as well be law. But I just don't think this happens here. You see if a practitioner does something outside of
these guidelines then they can end up being sued - as was the case with the Monash Gender Centre in Melbourne, Australia
for their misdiagnoses with a couple of transsexuals that rejected their gender reassignment. So the threat of possible
litigation is what makes medical services & support organisations toe the line nowadays because it can be argued in court
that a doctor or a psychiatrist for example was negligent for a misdiagnosis if the SoC are not followed. This is where I also
need to be very careful myself now with my role as the coordinator and chairperson for my support group. One little bit of
mis-information could get my arse or the group sued. So everything I publish now on the website has to be in keeping with
the SoC because that is also the guidelines for transgender health care in my region. To go against that is like hanging my
arse over the line waiting for a good kicking.

I agree also with Frances, there is no need to rush into things, usually those that do fall flat on their faces because there
is so much more to being a woman than just having SRS and its a shame that some people find this out the hard way. I want
my SRS ASAP as well & was approved sometime ago and if I was really desperate there are other ways I could get the money
real quickly for my SRS. But I am not 'that' desperate. My gender dysphoria has settled down a lot now, so I don't feel the
urgency I felt in the beginning because I have also come to realise that there was so much that I had to learn & get use to.
Luckily for me all seems to be coming together for me fairly quickly & smoothly, but I see others who have been under therapy
a lot longer than I have who are nowhere near the stage I am at because of the psychological issues they are yet to overcome.

Unless you really know yourself and are sure about everything would you ever attempt gender transition on your own outside
the SoC. But having said that I am also thinking now "Having a little bit of knowledge can be very dangerous". And that is how
I see it to be undergoing transition without proper support. Because even with professional medical help things can and will go
wrong. You cannot know about all the issues that can affect you or have any idea if you are in a situation of risk. I lost my gall
bladder, but I was warned just prior to this that it was showing some signs that something was wrong via tests down on my liver.

Oh and Kaitlyn... that was very well said ;)

[Fractured]

I respect the fact the SOC is being utilized as a treatment path for so many people. And I think Ver 7 is a large improvement compared to the 2001 release. The new document, besides changing the perspective of treatment, also provides more detailed information on the risks of treatment - the possible side effects of HRT and complications that can arise from SRS. I'm not sure if that is an effort to dissuade those treatment options or if it is trying to place more information at a physician's fingertips more easily. Regardless of the reasoning, I appreciate having that additional info in a easily located reference for both health care providers and for the public.

[HenryHall]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

The simple answer to "why anyone" is safety.

Perhaps not where you live, but living as a chick with a d**k will get you beaten up or murdered in many parts of the world. Surgery-first is the only physically safe route to transition. Even as some might argue that it is mentally unsafe. Following that SOC can put you in harm's way.

Surgery of course costs big money, but done first it also gets you out of having to submit to psychiatry which itself carries damaging stigma (psychiatry should not be stigmatizing but it really is stigmatized and some people (not everyone) strongly object to being stigmatized, mere water off a duck's back to other people).

Not for everyone, but I hope you understand that opinions and circumstances vary and there are some very solid reasons. For some people. Live and let live, some people are adult enough to take the responsibility personally, others definitely need help to share responsibility. Not for everyone.

[Frances]

The simple answer to "why anyone" is safety.

Perhaps not where you live, but living as a chick with a d**k will get you beaten up or murdered in many parts of the world. Surgery-first is the only physically safe route to transition. Even as some might argue that it is mentally unsafe. Following that SOC can put you in harm's way.

Surgery of course costs big money, but done first it also gets you out of having to submit to psychiatry which itself carries damaging stigma (psychiatry should not be stigmatizing but it really is stigmatized and some people (not everyone) strongly object to being stigmatized, mere water off a duck's back to other people).

Not for everyone, but I hope you understand that opinions and circumstances vary and there are some very solid reasons. For some people. Live and let live, some people are adult enough to take the responsibility personally, others definitely need help to share responsibility. Not for everyone.

I don't understand your point. Why would being a man with a vagina offer safety? What country are you refering to that people see genitals in the open? Besides, reputable surgeons follow the SoC. Are you recommending getting a hack job in a shady private clinic? The SoC are designed to maximize the chances of success and minimize the chances of regret, and they work. All the people that I personnaly know who are having a hard time with their transition went around the SoC guidelines.

The problem is not seeing a psychiatrist, but the mental disorder diagnosis itself. Some countries are doing away with it. People see therapists all the time, but trans people are considered mentally ill in a pretty universal diagnostic manual.

Since you put me to task in your last paragraph, could you please tell us a little about yourself? Your profile contains no information apart from your age, you have no photo and only two posts.

[Melody Moore]

Who the hell are you HenryHall to be coming onto this forum and
in your third post to dictating how gender transition should be?

Such an expert are we? to go against a large organisation like the World Professional Association of Transgender Health

The truth is having SRS or being pre-op makes no difference to the safety of a trans-woman.

Surgery first? You really have the cart before the horse and obviously don't have a clue PMSL

[HenryHall]

I don't understand your point. Why would being a man with a vagina offer safety? It doesn't. A man with a vagina would be an FTM doing RLT and this is also dangerous, though life is less dangerous for sexually unusual men than sexually unusual women.



What country are you refering to that people see genitals in the open?That is a straw man attack.
If you want an example of a person who was murdered for reason of being pre-op or non-op then Gwen Araujo would be a good example. There are lots more.
http://en.wikipedia.org/wiki/Murder_of_Gwen_Araujo


The SoC are designed to maximize the chances of success and minimize the chances of regret, and they work. All the people that I personnaly know who are having a hard time with their transition went around the SoC guidelines.Evidence for that design?
The SOC revision committee was pretty open about the fact that the SOC must protect surgeons from professional liability lawsuits. It is designed to do exactly that.

As to a hard time, all the people I have met who regret surgery are people who went through the SOC. None of the people I have met who hopped a jet to BKK and negotiated surgery after arrival have regrets.



The problem is not seeing a psychiatrist, but the mental disorder diagnosis itself. Some countries are doing away with it. The problems are (1) the stigma associated with having a psychiatric diagnosis and (2) The WPATH SOC requires a diagnosable condition to qualify for treatment.

As I have written elsewhere, a psychiatric diagnosis should not be stigmatizing. But that does not change the fact that it is stigmatizing.



Since you put me to task in your last paragraph, could you please tell us a little about yourself? Your profile contains no information apart from your age, you have no photo and only two posts.I confine my comments to the issues, not the personalities. I could mention that I am a citizen of multiple countries and have lived and worked on several continents.

[Frances]

I confine my comments to the issues, not the personalities. I could mention that I am a citizen of multiple countries and have lived and worked on several continents.

I wanted to know what made you an expert on transition. Are you trans? Have you started transitioning? Have you finished your transition? You are positioning yourself as an expert over people who have lived it and done it. So... who are you?

[HenryHall]

Who the hell are you HenryHall to be coming onto this forum and in your third post to dictating how gender transition should be? ..
I'm addressing the issues, not the personalities and dictating nothing.

But since you mention personalities, you appear to have an agenda that gender transition should be a certain way, not I.

My position is that different people have different needs and WPATH fails to address that beyond a quite limited extent.

[Melody Moore]

Henry, do you have any idea how many trans people there are on this planet?

There is well over 9000 here in Australia alone and you would be very lucky to even hear about a single
attack on one trans person here in Australia today. It is very obvious you don't have a clue and seem to
have an agenda to promote fear about gender transition. the new SoC are about the depsychopatholisation
of gender identity disorder and yet you claim we should just accept being treated for a "psychiatric diagnosis".


My position is that different people have different needs and WPATH fails to address that beyond a quite limited extent.
What a load of crap Mr Expert,

that statement in itself just proved you haven't even read the Standards of Care

I am really being to think you are an Anti-trans troll now.

[Kaitlyn Michele]

henry's agenda is to argue..don't get it into it with him...

he does not understand the meaning of simple words like often, and ignore
i say sayanora henry

[Beth-Lock]

Girls! Girls! Girls! (Not to mention boys.)
Just take deep breath and try and let go of all those negative emotions!

[Traci Elizabeth]

I love it when we get feathers flying. It always show me that we take ourselves way too seriously and think that our feelings are the right feelings for everyone else!

viva la fight

[Frances]

Girls! Girls! Girls! (Not to mention boys.)
Just take deep breath and try and let go of all those negative emotions!


I love it when we get feathers flying. It always show me that we take ourselves way too seriously and think that our feelings are the right feelings for everyone else! viva la fight

That is really your reading on this particular situation? Someone with no history and no established credibility comes barging in challenging and critizing everyone (read the posts in the other thread) and we are being hysterical? I must start shopping elsewhere. Long live the trolls I guess.

[Aprilrain]

The simple answer to "why anyone" is safety.

Perhaps not where you live, but living as a chick with a d**k will get you beaten up or murdered in many parts of the world. Surgery-first is the only physically safe route to transition. Even as some might argue that it is mentally unsafe. Following that SOC can put you in harm's way.

I will reserve comment on the Idea that some people may get SRS ASAP and have a successful transition. I'm sure there are examples out there. I'm totally confused as to how "Joe exec" with deep pockets gets SRS, and is now totally passable as a woman? I'm picturing some middle aged guy with a short male haircut and grey 5-o-clock shadow that is fully visible by 3-o-clock everyday has never gone out or done anything in the world as a woman and sounds like Berry White but now has a pussy! How does that help him?
Gwen Araujo is a good example of a young woman who had sex with the wrong guys. One was like mexican mafia and in order not to get killed himself and of course to prove some macho man bull shit Killed her! The only reason they knew she was trans was because she HAD SEX WITH THEM!!!!!!!!!!!
I know another non ops who has put herself into very dangerous situations because she likes those gansta thug type guys which has more to do with that whole lame culture than it does with the fact she has a dick in her pants. Natal woman don't get treated much better by guys like that.
SO! Gwen Araujo is not a good example of someone who just gets beaten up at random because she is pre op. Gwen's death was tragic no doubt and I do not blame her for her murder but had Gwen not had sex with mexican mafia she probably would still be alive. Natal woman fall for "bad boys" all the time and end up dead too.

[Sharon]

Aren't we getting carried away reacting to one person's posts the way that is going on here? No matter how outrageous or misguided you may believe an opinion is, an opinion is just that and it has no effect on anyone else. Meanwhile, the thread topic itself is forgotten.

[Hope]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

I agree with you 110% that social transition is the biggest hurdle. For me social transition has always been THE point of all of this. There was a long time where I didn't think I would need to have SRS at all... While I personally have very few issues with the old SOC (and I think almost 0 with the revised SOC) and I have NO issues with RLE I also recognize that my situation is not universal. And the research doesn't show a large distinction in post operative regret in those folks who did RLE and those who side-stepped it and didn't do RLE... So I am not sure that RLE is doing what we are hoping / thinking / expecting that it does or should do either. I guess that while I don't have a problem with it personally, I am not sure I see the need for it either.

I think my biggest issue with RLE is simply that there is a fundamental problem with the idea that we have other people deciding what we can and cannot do with our bodies. In no other population would that be tolerated. In no other population would such a fundamental right to self determination be tolerated. RLE reinforces cis privilege, and makes the lives of lots of trans people needlessly difficult.

I get where you are coming from, but the SOC (particularly the old ones) needlessly put hoops in the way of girls who don't need them. Reading the T-vox article on cisgender privilege really opened my eyes on this one.

http://www.t-vox.org/index.php?title=Cisgender_privilege

If someone feels that they are ready to make that sort of a step (Because no one makes it on a whim), and is mentally competent (a determination that can be made in less than an hour) and can afford the cost - why should they be stopped? And what right does ANYONE have to tell them that they can't do what they wish, when they wish, with their own body?

And yes, the DSM is not helping either...

[Rianna Humble]

If someone feels that they are ready to make that sort of a step (Because no one makes it on a whim), and is mentally competent (a determination that can be made in less than an hour) and can afford the cost - why should they be stopped? And what right does ANYONE have to tell them that they can't do what they wish, when they wish, with their own body?

This is exactly the attitude shown by Charles Kane who gets trotted out on the US news channels to say what rubbish Gender Dysphoria and the whole transition process is because he used his money to side-step the SoC, transitioned to look like a woman, didn't like what he found and then did it all in the opposite direction. As is frequently the case when people do something like that, he blames doctors and psychiatrists for the fact that he had the attitude "I can afford the cost,I can do what I like when I like with my own body"

[Sophie_C]

Ok, I'm going to more directly elaborate on what many are saying: The SOC exist for not only the people transitioning but more importantly for the legitimacy of the community as a whole and your rights as a trans person.

While clearly over 99% of people who transition remain as a woman for good, all you need is just a handful of people who are insane who also think they are transgendered, transition rapidly and then come to regret it, then speaking out against it (like Charles Kane), and you get everything to revert back to how things originally were - people looking at it as a mental disorder, and worst of all, a "choice."

By having the SOC and requirements for psychologists to be involved, it weeds out those people who clearly have other issues at play, the truth will not be shadowed by some truly confused people, and your rights will remain protected.

It's much like how not having the death penalty works. It's not about the guilty people, who deserve the ultimate punishment for their crimes. It's about protecting the innocent people who will eventually fall through the cracks. The SOC protects YOU so that you may be able to be the woman you are, even moreso than the handful of people who go down the same path but are really men, inside.

P.S.: This doesn't mean that I criticize people who start on their own path without it. Everyone has their own way, especially if you're slow and highly certain. But, if this system does not exist, then attacks on the community will work and all true trans women will remain further endangered, since our identity remains in question. This is why trans rights remain lagging behind other LGBT rights. People like Charles Kane speak, no one knows his background, and they begin disbelieving everything about us and dismantling all of our rights. That situation must be stopped.

And, the more people who follow it, the better (again, more legitimacy), but if you're out of the mainstream, who cares?

[Kaitlyn Michele]

Well said sophie...

Charles Kane hurts everyone. His comments gain legitimacy because of his willingness to do anything for attention, and because so many people hate us and/or want us to fail...they disbelieve us...
All we need is a couple more loons like him, and we are gonna lost 20 years...after that special, i had two people call me and ask me if i ever regretted it... they WANT me to regret it.. this is something we all face every day and its very insidious...

Leaving the DSM out of it..
The SOC is important..overall its a very helpful document.. there are needless hoops in there for sure as Hope pointed out.....and many of us have a built in human dislike for psychiatrists....but they serve a function too, and the right medicine can greatly improve a persons quality of life...

I have been guilty of my way or the highway thinking, but I hope I'm not dogmatic about it...I'm learning, and I read this version and I felt very good about it.. Picking it apart and focusing on specific words doesn't change that its a positive document and reflects a state of the art thinking that's out there.

[Zenith]

I regret with all my heart being put on this earth a transsexual. But I don't regret finally facing the truth. And dealing with it. I feel free for the first time in my life.

[gretchen2]

eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee

[Aprilrain]

imagine how I felt when the image popped in my head! : P

[Hope]

I'm sorry, I don't think that we should all be punished because there are a couple of nut-jobs in the world who do things impulsively and don't consider the ramifications of their decisions before they have permanent life-altering surgery.

I don't need a nanny. The community doesn't need a nanny. Regardless as to weather or not that nanny is a Dr. or a legislator - they are not necessary. Or welcome really. Maybe you need "protection," what I need is access to health care.

Don't get me wrong - I support people going to therapy. I am PRO-therapist. I freaking LOVE mine. I think people SHOULD be under a Physicians care in order to get hormones. but I don't think that there should be all of the absurd requirements that need to be fulfilled in order to get what amounts to a medical procedure. Access to health care is a human right, not something that can ethically be supplied only to those deemed appropriate or worthy.

We should ALSO be expected to be held responsible for the decisions we make... but we don't need nannies.

[Rianna Humble]

I don't need a nanny. The community doesn't need a nanny. Regardless as to weather or not that nanny is a Dr. or a legislator - they are not necessary. Or welcome really. Maybe you need "protection," what I need is access to health care.

Unfortunately, Hope, you appear to be arguing that this access should not be based on the best professional assessment of health needs but on ability to pay. The SoC exist to try to ensure that healthcare providers adopt best practice in catering to the very real differences in health needs of the gender variant population. By saying, as you did previously that if someone has the funds to pay that should be the only standard rather than how the procedure might affect their general well-being you appear to be arguing for something very different to healthcare as a human right.

[Melody Moore]

Yes I really like how people here are being critical about the Standards of Care without even considering
what benefits they do provide. And truth be known their treating therapist and doctors are most likely
following the SoC anyway whether they like it or not. I think before some people run down the SoC they
really should go and have a good read to understand what benefits this really does bring to the transgendered
community and they may in fact discover they have been following the SoC and never really knew it. So
many 'know-it-alls' here that know nothing. I am happy and proud to admit I am still learning day-by-day.

[Kaitlyn Michele]

I regret with all my heart being put on this earth a transsexual. But I don't regret finally facing the truth. And dealing with it. I feel free for the first time in my life.

Pefectly said..

look at how easily charles kane can get his voice heard... this is because alot of people are against us...

The renee richards espn movie has her talking about "regret" .. the exact way julie said it...she is bummed about her son, the way she transitioned, that she HAD TO transtion...but she doesnt regret that she faced her reality..and even the cd's that watched that show all gravitated to that comment..in the cisgendered world, i have two friends that called me to say they saw the show...and they BOTH said.."so do you regret transition?? UGH!!!"...


Hope, i think you have to weigh costs and benefits... when you say "I DONT THINK we SHOULD be punished because there of a couple nut jobs...." I totally agree with you... But how do answer the problem that people do punish us because of those nut jobs... overall, the imperfect SOC PROTECTS YOU AND ME from those people... also the SOC does not tell people who and what they are...sometimes I think people avoid looking at it because they are somehow afraid of what they are going to read...
why wouldn't a person want to understand what other people are doing and saying...

i read the SOC and twice and mostly agreed, somewhat disagreed..I'm sorry Gretchen but I don't view it as a positive to ignore a document that literally 1000's of well meaning people worked on..

there is good and bad in everything. The SOC is mostly good...

[Rianna Humble]

I've known who and what I am my whole life and not once have I looked at the standards of care, and I never will. I know deep down in my soul what I need to do and the SOC plays no part in it.

Given that you have not read the standards of care that are supposed to guide the health professionals who support you, how do you know that they are irrelevant?

[gretchen2]

dddddddddddddddddddddddddddddddddddddddd

[GirlieAmanda]

I am right on the cusp of HRT and I like the new standards. I like the improved flexibility and care. I think they were instituted for a reason. They are there to help trans people not to govern someones insides. These people are taking the time to care for trans people and help them through a very difficult life. I am going to find a therapist as soon as I settle in my new area of South Carolina. I will then hopefully be able to start my HRT regimen after a few sessions. My RLE has been pretty good and I think I do pretty well around the public. I am still learning all I can including studying the SOC and forcing myself to go to even the most mundane places presenting as a female. I am still in the beginning stages but yet have a good bit of confidence. My "sage" friend who is a full time TS who lost everything and is starting over has gone through so much with her demons as well. She has conquered both and inspires me to be genuine and real. She is very intelligent and she followed the SOC.

[Melody Moore]

I think that the SOC is great for people who are not sure of who and what they are.
I think that would have to be one of the most ignorant comments I have ever heard about the SoC,
because really it has nothing to do with this at all, it is about the STANDARDS OF CARE for health
professionals and support organisations to refer to for treating Gender Identity Disorder, Gender
Dysphoria and the management of other gender related issues.

Like many others I already KNOW I am a woman, however there are Standards of Care that must be followed. It isn't
my choice I have to follow the SoC, the SoC is how the doctors, my therapist etc are advised to manage my condition.

I really would urge you to read them before you make another ignorant comment that proves you don't
have a clue what you are talking about or even commenting on. I also strongly suspect that all your
treating doctors etc have been managing your therapy and treatments in accordance with the SoC.

[Julia_in_Pa]

I fully an completely agree with you Frances.


I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

[gretchen2]

vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv

[Rianna Humble]

I did not say that they are irrelevant for you. I said they are for me, so far every decision that I have made on my own has been backed up later by a Doc. or a therapist, and the only reason that I have seen either is for SRS papers. I think that the SOC is great for people who are not sure of who and what they are.

Again, as you don't know what the Standards of Care say, how do you know that they are irrelevant to the care being provided to you by the health professionals that you have consulted?

You may choose to remain ignorant of what the SoC say, but that does not mean that health professionals will ignore professional standards of care.

[gretchen2]

bbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb

[Rianna Humble]

Rianna I do realize that my Doctor and the Therapist both follow the Soc to a point,

You have just contradicted your opening statement that the SoC were irrelevant in your case. The Standards were written by health professinals for heatlh professionals to guide them in a professional relationship with their trans patioents.

Incidentally, I find it interesting that questioning how you know something is irrelevant without knowing what it says is me pushing a point of view upon you. It would appear that we truly are divided by a common language.

[Cindi Johnson]

Is the SOC the bible? Maybe handed down from on high?? If so, then surely we are both right and righteous to jump all over anyone who takes issue with them, like Gretchen.

I am 60 years old. I've felt myself female since when, maybe age 4? Yet many of you all think I REQUIRE a therapist in order to get a prescription. No, not just the permission of a physician. I REQUIRE a therapist to tell me what I feel. After all, I'm just a simple fool, ignorant of TG matters. Forget the fact that I've had more education than the therapist, that doesn't matter. Ignore the fact that I've dealt with TG matters on a very personal basis for 60 years, whereas the typical therapist knows squat about us. Just don't question the holy SOC!

It's not a problem to question authority. I'd just like to say that maybe, just maybe, we should be a little less inclined to attack those who do.

[gretchen2]

zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

[Rianna Humble]

both right and righteous to jump all over anyone who takes issue with them, like Gretchen.

It's not a problem to question authority. I'd just like to say that maybe, just maybe, we should be a little less inclined to attack those who do.

Why is it an attack to ask someone how they know that something they have never read is irrelevant to the way that health professionals treat them?

[Melody Moore]

That is just priceless Gretchen, you can't provide a solid argument about the SoC because you have never even
read them, now you were caught out in a total contradiction so you resort to personal attacks - just priceless ;)

We are not discussing if being a tranny, or a non-op or pre-op here is the right or wrong thing. I have said
many times I want my SRS to make me feel complete. So how about you just get over yourself and either
contribute something positive or constructive about the SoC to the discussion or just move on eh?

[Kaitlyn Michele]

Why is it an attack to ask someone how they know that something they have never read is irrelevant to the way that health professionals treat them?

Simply stated, Gretchen can do whatever she wants..
However, her comments on this topic have exactly zero value to anyone. why would anyone care about what she has to say about this?

its like when somebody says hey did you see that movie (which you didnt see) and for some reason you are compelled to make a comment as if you did....oh yeah, that movie, i liked the 2nd part..

[Melody Moore]

I am going to see my gender clinic today, I am going to ask them why they must follow the WPATH SoC
but I strongly suspect it is Queensland Health (the public health service) who defines this policy for them.

While I don't know how things work in the USA, I suspect Doctors would turn to the WPATH SoC because
there is no other SoC they can follow. If they are not following these guidelines it also sets themselves up
for case of serious malpractice and litigation if something goes wrong. If I was a doctor I certainly would be
using them for that fact alone.

[Melody Moore]

Well I am back from my meeting with my therapist and this was a very interesting discussion because I did raise the
issue about the new SoC and why they had to follow them. It seems that I was right on the money in my last post.

If they don't follow these guidelines with has been put together by a well informed professional group of people in
transgender health care, then you are setting yourself up for a case of malpractice and litigation if something was to
go wrong. So all of you people out there that don't think you don't have to follow the Standards of Care, then be
aware that you really probably have no choice in the matter just like me - your treating doctors and medical staff
are most likely making sure you follow the SoC already regardless of what you might believe.

Personally I would not want to be treated by any doctor who didn't follow the Standards of Care with my treatment
because obviously such a doctor would just be like Gretchen and have no clue whatsoever about the right and wrong
way to manage gender identity disorders, gender dysphoria or any other gender related issue. Being aware of what is
in the SoC helps to ensure that you are getting the best type of treatment from those who are providing services to
you. The SoC is also invaluable to how my support group is restructured and my therapist was totally 200% behind that
because we as a support group have to also ensure that the services we provide also comply with the guidelines or we
might find ourselves getting sued for a gross case of negligence because ignored or overlooked some aspect of the SoC.

The SoC is your best friend really and I really don't know why so many people take such an issue with it - open your eyes folks!

[HenryHall]

... The SoC is your best friend really and I really don't know why so many people take such an issue with it - open your eyes folks!
To answer that directly, the reason (right or wrong) why many (Europeans at least) take issue is that the HBIGDA/WPATH SOCs have more or less made it mandatory to use a mental health professional of some sort and to discuss gender presentation issues with that professional.

Being required, incentivised or pressured by a government-funded agency to engage in such discussions contravenes Article 8 of the The Convention for the Protection of Human Rights and Fundamental Freedoms (commonly known as the European Convention on Human Rights 1953, as amended up to and including 2010).
See http://www.pinknews.co.uk/2011/09/29/european-parliament-calls-for-end-of-classifying-transgender-people-as-mentally-ill/
and http://www.lgbt-ep.eu/wp-content/uploads/2011/09/RES-20110928-Human-rights-sexual-orientation-and-gender-identity-at-the-United-Nations-As-adopted-Provisional.pdf
See especially paragraph 13 of the above

But I do realize that your question is rhetorical and you don't actually care to know why. To some people such issues are unimportant. I hope you see they are not unimportant to everyone and can agree to differ.

[Beth-Lock]

I am no friend of those who advocate forced psychiatric treatment outside of extreme circumstances, but:

1) With the Standards of Care, it is more like compulsory diagnosis, which is prudent anyway. Even many Christian Scientists who do not believe in any medical care, will get a diagnosis, and use it to change their lifestyle or diet, etc., in short to be guided by any insights that turn up. Getting a diagnosis is essentailly harmless.

2) It is, considering the rate of suicide and other mental crises, in transitioning TS, only prudent to get a contact in the world of psychiatry and psychology, before you have a crisis. Not every case, for example, of self-mutilaition ends happily as one did here, with a sympathetic doctor doing a vaginoplasty during the crisis, when the patient was rushed to emergency.
My own case converted me, since I started out, on my own, and soon realized I needed help, as I got beyond my depth in conflicting emotions.
What we are talking about is a special case, like having an ambulance stand by at a race track, even when nobody needs medical help. Most trans will sonner or later need help though, including possibly the prescription of some medication to deal with depression or counselling therapy.

3) Since most TS start the process naive and not having a clue about the seriousness of the problems they are likely to encounter, it is wise for professionals to offer A SYSTEM TO FOLLOW IN TRANSITION, which has proven to help avoid or at least deal with the dire problems likely to be encountered, all too often. It is a mercy, not an authoritarian gesture.

4) Since public medicare systems are paying the cost, they are entitled, like he who pays the piper, to call the tune. Some of these countries even allow those who pay their own way, to deal with a surgeon on any terms the surgeon is comfortable with, including ignoring the Standards of Care, in part, or completely, in exchange for money. If one cannot get such a surgeon in their own country, there are lots of quacks in the wide world who wil oblige, and no modern country will prohibit their citizens from travelling and seeking them out. Where is the compulsion then?

5) Why is it a worry in European countries? Most European countries, at least the Northern ones, are socialist to a degree that the rest of the world has not followed. If they want to set standards for regulation of their much more intrusively interventionist govenments, fine. But you cannot apply those standards validly to non-socialist countries, unless or until they too become socialist to that degree. A European problem is not a universal issue.

[kellycan27]

TBPO I have never read the SOC. After my second unsuccessful suicide attempt I was ordered by the court to see a psychiatrist or face 6 months in an institution. I showed up for my first appointment as "Kelly" . after the preliminary introduction and explanation of why i was ordered to see him, he asked me if I thought i was a girl. I rolled my eyes and said, no.. i think I am a boy who should have been born a girl. On my second appointment i was handed off to a female psychiatrist who was versed in gender issues. After discerning that my GD was not my motivation for trying to end my life she handed me back off to the first doctor, but she also referred me to a gender therapist who after my third session set me on the road to transitioning physically.
She basically told me that there was a procedure that must be followed in order to proceed, and she laid it out. I followed it... that's pretty much how it went. I guess that i never really thought of it as the government's way of controlling me or them trying to control what i did with my body, but more a way of helping me to accomplish my goal. I went from not having a real plan to having a path to follow. In the end... it worked out better than I could have hoped for because my transition went pretty smoothly with her guidance. YMMY.

Kelly

Footnote: I continued to see the court ordered shrink who found me to be "quite hostile" at his attempt to cure me. He was convinced that my suicide attempts were rooted in my GD. :battingeyelashes:

[HenryHall]

I am no friend of those who advocate forced psychiatric treatment outside of extreme circumstances, but: ...
Dear Ms. Beth-Lock.

I totally agree with all you wrote in that post.
None of what you wrote bears on the human rights issues however.

Q. Are the very good reasons you set forth sufficient reason to waive enforcement of human rights in general?
Opinions vary, but the 27 nations of the European Parliament and the 47 nations of the Council of Europe (including Russia which is not entirely European) have asserted, through the democratic process, that Article 8 of the ECHR should be enforced, including especially in a context of the "the transsexual journey".

[Cindi Johnson]

By REQUIRING transgendered to seek therapy, society is in effect stating that transgendered are mentally unstable. Until we prove otherwise, we are mentally unstable. How do we prove otherwise? Well, we MUST seek the advice and blessing of a therapist. So what do we do if the therapist tells us no, he won't approve? (Yes, it happens, particularly with the many religious-oriented therapists.) Well, most TG's shop around until we find a therapist who agrees with us. Wow! That makes a whole lot of sense. We agree we need therapy, but ONLY if the therapist agrees with our interpretation of our situation. Then too, maybe where Beth lives the public pays for all this, but where I live it comes out of my pocket.

If even we are so willing to concede that transgendered, by their nature, are mentally unstable, is it any wonder that society as a whole would think the same? What other groups in America are subjected to forced therapy? The gays would never allow this without a real fight. Other than mothers who murder their own offspring, I can't think of any group that is presumed to be mentally unstable. Yet not only do we not protest our classification, we embrace it.

I do not understand this. Never will. And no, I have nothing against VOLUNTARY therapy.

[Rianna Humble]

By REQUIRING transgendered to seek therapy,

I'm curious, is it a government agent who is standing over you with a gun (or threat of imprisonment) to force you to seek help? Which agency would that be?

[Frances]

I understand the viewpoint of all the people here against the SoC, but then again, all the people that I know that detransitioned went around the SoC and did not want the therapy. I go to support groups and am somewhat involved in the trans community in Montreal, and I have seen a lot of people who wanted access to hormones and surgery NOW or they were going to give up on the whole thing! Most of them did. Transition is a waiting game, and if a person will stop the transition process because the wait is too much to bear, then they may not be trans after all. Finding that out after surgery can have dire consequences.

[Beth-Lock]

Before any other newcomer gets confused, I would like to point out that my name is not Beth-Lock. I chose this pseudonym because I liked the name Beth and it was already taken on this board, so I added "Lock," since it popped into my mind, as I was shopping for a padlock for the gate at the time, (as I have explained in a prior post on name choice). Beth eventually became my real name long after I chose my pseudonym for this board, so the whole name thing then took another twist! I eventually regretted choosing the "Lock" part, because there are some well-known people named Beth with that last name, people with whom I would not want to be confused.

It seems the commonly followed style on this board, is to address people using their log-in name, without adding Mr., Miss or Ms., etc. Anything else seems jarring.

[Starling]

I regret with all my heart being put on this earth a transsexual. But I don't regret finally facing the truth. And dealing with it. I feel free for the first time in my life.

This deserved being quoted again. I agree TS really is a curse, at least in this world, and I truly wonder at anyone who can nonchalantly assert that it's so cool to be trans. I think what's really cool is never having to agonize about the second most basic existential issue after life itself: Are you a boy or a girl? It should be an easy question, and for more than 99% of the world's human beings, it is.

The price we have all paid is the loss of well-being, a persistent queasiness in the center of our soul. And when we finally come to grips with what must be done to get some blessed relief, the world works overtime to compound the shame and guilt we already feel like a knife in our heart, just for trying to get what everyone else takes for granted: a little peace within.

That being said, I don't want to spend the rest of my life pissing and moaning, and I hope in a few years I'll be able to say what Zenith said. I had my first meeting with a gender therapist on Sunday.

I'm so impressed by the people I have encountered here. I salute you all for having the guts to risk everything for a chance at true happiness. You are champions.

:) Lallie

[CharleneT]

Without going into the morass that is any discussion of the SOC I wan to point out one thing. Because those std's exist, and people follow them, we are allowed medical care that used to be refused to TS folks. Sure, it looks like just a bunch of hoops, but actually they work pretty well. Sure, it is a bitch that you have to get classified as having a problem .... but you know, I've never met a TS person who didn't have some problems developed from years of hiding and surpressing. Getting a diagnosis gets you some medical insurance coverage. Does it cover SRS, not very often -- YET. But that is coming and I think sooner than most believe. I think we all forget that we are living in the middle of a big change in the way that trans folks are dealt with in the world. Some patience right now is likely to go a long way to rewards for future people who need to transition.

Old Chinese curse: may you live in interesting times.

We are :doh:

[kellycan27]

By REQUIRING transgendered to seek therapy, society is in effect stating that transgendered are mentally unstable. Until we prove otherwise, we are mentally unstable. How do we prove otherwise? Well, we MUST seek the advice and blessing of a therapist. So what do we do if the therapist tells us no, he won't approve? (Yes, it happens, particularly with the many religious-oriented therapists.) Well, most TG's shop around until we find a therapist who agrees with us. Wow! That makes a whole lot of sense. We agree we need therapy, but ONLY if the therapist agrees with our interpretation of our situation. Then too, maybe where Beth lives the public pays for all this, but where I live it comes out of my pocket.

If even we are so willing to concede that transgendered, by their nature, are mentally unstable, is it any wonder that society as a whole would think the same? What other groups in America are subjected to forced therapy? The gays would never allow this without a real fight. Other than mothers who murder their own offspring, I can't think of any group that is presumed to be mentally unstable. Yet not only do we not protest our classification, we embrace it.

I do not understand this. Never will. And no, I have nothing against VOLUNTARY therapy.

You must be living under a rock or something. There a lot of transsexuals who ARE mentally "unstable". Maybe not mentally "ill" but unstable for sure. For some being transsexual is all consuming to the point that it negatively affects almost every aspect of their daily lives. It affects their jobs, their social interaction with friends and family, their ability to have relationships. These issues can also lead to physical illness and in some cases suicide. Some people seem to think that The SOC is a way to interfere or maybe dissuade transsexuals or in the very least make it difficult. In my 9 years of living full time I have seen way more mentally "unstable" transsexuals than I seen who were "stable". The one's that i have met personally that did have a better handle on their trans sexuality where the one's who had already fully transitioned, and who had gone through the "process", and even some of them still had some issues that they were still having to deal with. I was really surprised at the number of younger transsexuals who due to their mental "instability" cannot get work, or who are on some kind of government aid ( disability). Some of you may know your rights, but it is apparent to me that and ( judging by a lot of the responses here)you have absolutely no clue as to what is is truly like to be a transsexual. I think maybe that some of you people should take the time to read some of the threads and posts right here in the TS section and see how many "happy and content" stories there are compared to the one's from people who are struggling and trying to work through issues.

[Frances]

In my 9 years of living full time I have seen way more mentally "unstable" transsexuals than I seen who were "stable". The one's that i have met personally that did have a better handle on their trans sexuality where the one's who had already fully transitioned, and who had gone through the process, and even some of them still had some issues that they were still having to deal with. I was really surprised at the number of younger transsexuals who due to their mental "instability" cannot get work, or who are on some kind of government aid (disability).

Same here. In my city, most of the unstable ones do not want to go the Montreal General's human psychiatry clinic, the only place that follows the SoC. They follow their own path with varying degrees of success, but are not well-integrated into society, are often unemployed and on some kind of disability program.

[Starling]

And alas, they may be the ones with the greatest pain and need. My heart goes out to them.

:sad: Lallie

[Cindi Johnson]

You must be living under a rock or something. There a lot of transsexuals who ARE mentally "unstable".

I know of a few Muslims who were mentally unstable about ten years back. Maybe ALL Muslims need therapy? I know of more than a few Southern Baptists who are mentally unstable; I'm all for therapy there, REQUIRED by society. I can go to the bar near my house most any night and find mentally unstable drunks, so, let's bring in the therapists. Maybe even your own family has had a quirky member or two; so, ALL your family must now go to therapy, it seems. If not, you are being a bit inconsistent, aren't you, Kelly? After all, you support requiring me into forced therapy because someone YOU know is mentally ill.

As I said before, I'll never understand. I'll stand by my previous posts.

[Aprilrain]

Maybe ALL Muslims need therapy?

wouldn't bother me..................

[kellycan27]

You must be living under a rock or something. There a lot of transsexuals who ARE mentally "unstable".

I know of a few Muslims who were mentally unstable about ten years back. Maybe ALL Muslims need therapy? I know of more than a few Southern Baptists who are mentally unstable; I'm all for therapy there, REQUIRED by society. I can go to the bar near my house most any night and find mentally unstable drunks, so, let's bring in the therapists. Maybe even your own family has had a quirky member or two; so, ALL your family must now go to therapy, it seems. If not, you are being a bit inconsistent, aren't you, Kelly? After all, you support requiring me into forced therapy because someone YOU know is mentally ill.

Did i say that? I was addressing that which you said in regards to mental health. i was only stating that there are a lot of mentally unstable transsexuals. I never said that everyone should be subject to forced therapy.

As I said before, I'll never understand. I'll stand by my previous posts.

Did i say that? I was addressing that which you said in regards to mental health. i was only stating that there are a lot of mentally unstable transsexuals. I never said that everyone should be subject to forced therapy. maybe a therapist could help you get over these feeling you have about being "set upon" when it's just in your head. :heehee:

[Starling]

I just started gender therapy to help decide what to do about what I already know about myself. That's the really scary part for me, and I want some expert help in making this big change as endurable as possible for the people I love. I don't feel there's a stigma attached to to it, nor would I expect anyone who knew me to think any less of me. Quite the opposite, I'm pretty sure. And if this work gives me SOC brownie points, that's a bonus. I need all the help I can get.

:) Lallie

[Frances]

I don't feel there's a stigma attached to to it, nor would I expect anyone who knew me to think any less of me. Quite the opposite, I'm pretty sure.

Me neither. As a matter of fact, the idea of the SoC made everyone (including my workplace, family and friends) understand that this was not a lifestyle choice. I have used the SoC as a selling point to reassure them. But then again, it was not a lifestyle choice. Maybe it is for others.

[Hope]

Unfortunately, Hope, you appear to be arguing that this access should not be based on the best professional assessment of health needs but on ability to pay. The SoC exist to try to ensure that healthcare providers adopt best practice in catering to the very real differences in health needs of the gender variant population. By saying, as you did previously that if someone has the funds to pay that should be the only standard rather than how the procedure might affect their general well-being you appear to be arguing for something very different to healthcare as a human right.

I have this funny thing about human liberty - I like it.

What I am suggesting, dear Rianna, is that individuals should be in charge of our own health care and our own treatment needs. That access should be based on an individuals need - not on an individual's ability to pay, nor on an assessment by a third party.

Frankly, I am the sort of crazy socialist that thinks that health care is a human right and should be free - my comment about cost was merely a recognition of the morally bankrupt system as it actually exists in my nation.

I GUARANTEE you - that you are 1 "professional assessment of health needs" that disagrees with your desires away from agreeing with me.

Yes, there are "very real differences in health needs of the gender variant population." No one knows that better than a member of said population. I just think that those individuals who will be undergoing treatment, and paying for it (sadly) have a better idea, or at least more right, to make decisions about their individual health needs than any one else.

As I stated, what I have is a fundamental problem with the idea that we have other people deciding what we can and cannot do with our bodies. In no other population would that be tolerated.

[Sophie_C]

You know, I think people just breezed over what I posted.

The SoC exist NOT to make things harder for those who are truly trans. They are to weed out the crazy, non-trans people who have other issues going on they think are at least some way in related to gender identity, when they are not.

If you don't have the SoC, or the majority of people do not follow them, then you're going to get all sorts of people transitioning (when they shouldn't), remaining crazy, regretting it, transitioning back and then doing everything in their power to de-legitimatize everyone who is truly transgendered.

The SoC protect YOU. Even if they're a pain in the ass, they're set to keep a real and serious understanding of the situation you are in, by having it done in a controlled, scientific and decent manner.

So, don't complain or feel persecuted by the SoC's presence. If they didn't exist, all you'd need is a few crazy idiots, and every inch of progress made could be completely undone. All rights, all understanding, all dignity would be torn away and people would see it as insanity, or equally as bad, a choice.

Does no one understand this?

[HenryHall]

... The SoC exist NOT to make things harder for those who are truly trans.
The SoC protect YOU. Even if they're a pain in the ass, they're set to keep a real and serious understanding of the situation you are in, by having it done in a controlled, scientific and decent manner. ...
So, don't complain or feel persecuted by the SoC's presence. If they didn't exist, ...
Does no one understand this?
I believe you will find that the above is understood by just about everyone and generally agreed. Well, with a possible exception as to "decent".

It is not the presence of the SOC that people feel oppressed and persecuted by or complain about, because most everyone agrees that there should be a SOC document.

Rather it is the contents of the SOC that is objectionable, and for multiple reasons.

[Nicole Erin]

Problem with therapists is if they had their way, every last human would be in therapy. Of course their main target are parents of younger kids. Each time a kid screws up in school, they scream "autism". To therapists, it is merely a game.

So basically with TS women like us, many of us don't pass well enough to really settle into a decent life, which partially means working for next to nothing. Well, except the younger prettier ones who can escort. So we are broke and then some SoC is saying we need to pay a fortune for fancy doctors. Or if you wait too long, like beyond age 18, your transition may not be as successful. But what kid has $1,000's to spend on doing it the SoC way? With the older ones who might have the money, what happens when their entire life crashes cause all the sudden they are trying to live as a woman, par the RLE?

The only ones the SoC filters out are the ones who are broke. So those of us who are broke basically have to do the best we can with what we have.

I live full time in my new role, well, more "exist" full time (being single and broke is not "living" for any gender) but the point is, I didn't need to talk to some "therapist" about this.

And with filtering the true loons, alright, do they REALLY think there are droves of lunatics out there who have the money to go get SRS on a whim?

The medical field has a habit of sending people to doctor after doctor, milking the patients' funds, all in the name of "go see GP, go see specialist, go see another specialist...

[Melody Moore]

So basically with TS women like us, many of us don't pass well enough to really settle into a decent life, which partially means working for next to nothing. Well, except the younger prettier ones who can escort. So we are broke and then some SoC is saying we need to pay a fortune for fancy doctors. Or if you wait too long, like beyond age 18, your transition may not be as successful. But what kid has $1,000's to spend on doing it the SoC way? With the older ones who might have the money, what happens when their entire life crashes cause all the sudden they are trying to live as a woman, par the RLE?

Nicole I really urge you not to get strung along by the lies, propaganda and conspiracy theory another poster is trying to hatch
here. I personally like the new SoC and I don't see much wrong with them except the classification of gender issues falling under
the DSM is still a sore bone of contention that WPATH is also trying to overcome in this version but fell well short of achieving that.

Now for your allegations that gender transition is only for the rich - sorry but that statement is NOT true!

In many places transgender health services are subsidised and paid for under public health systems. The
new SoC has more inclusion of other gender variants to be included in transgender health services because
they also have health issues to deal with but that doesn't always equate into therapy and treatments for
gender transition. I think this SoC will weed out a few that make mistakes with gender transition and this
has to surely be a threat to those that don't fit the criteria for specific therapies and treatments. The only
legitimate gripe I have heard has been about the inclusion of gender identity disorders in the DSM, the rest
is just utter nonsense.

[Aprilrain]

Since when was anyone other than YOU obligated to pay for Your medical wants or needs? Is this thread about the usefulness of the SoC as a guideline for treating trans people or is it a political debate about private vs. public funded health care? regardless of the system you live with Doctors are going to want to get paid! they are going to want to be well compensated for the many years they spent in school to become SKILLED surgeons They are going to want to off set their considerable liability with greater compensation. This is how it works, someone is going to have to pay for it! As certain members here have pointed out even in Canada where health care is "free" $$$$$ were payed out of pocket to make transition happen. Since there is a political element to this debate hers my 2 cents, no system is perfect however the system with the greatest freedom of choice is going to be the one were the user pays directly. in a socialized system the patient is at the mercy of bureaucrats who's job it is to decide wether a service is "necessary" or not. transgendered health care represents a vanishingly small number of the population as a whole compared to say senior citizens who's health care needs are many and who's numbers grow larger everyday! who's going to get the axe when they are looking for a convenient place to save a few bucks??????
consider, who thinks BA should be considered a "necessary" treatment for a natal woman who just wants bigger boobs? what about a natal woman who just feels her face is too masculine? should FFS be considered a necessary procedure? Lets say "they" determine that SRS (or whatever you want to call it) is indeed medically necessary for a transwoman's long term mental health, but hair removal, BA and FFS are considered elective then to top it all off they TELL YOU which doctor is going to preform this surgery on YOU because he or she is the one who they are willing to pay! HHHHHMMMM? SRS with joe shmoe for free with questionable out comes or cough up the money for a surgeon with a world renown reputation??????

[Kaitlyn Michele]

great points april...

fyi the SOC is not about "weeding out the crazy people.." to me, that kind of talk gets ts people in trouble.. gender variance is a human condition..
it reduces you if you truly believe this, and comments like this are what set off other gender variant people..being transsexual doesnt create an extra right for you..
it's important to separate out people that will not be well served by transition, but it's not a value judgement, people that pursue transition while NOT TS are not "loons"... they need help to learn that transition will not suit them

i have met alot of ts people...our loon ratio is quite high vs the general population

the SOC is about creating a template that people can use to hopefully help..

feel free to parse it word for word...its a waste a time and energy...nobody looks at the SOC as a set of rules to be followed line by line..

[Christy_M]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

I can give a good reason to rush to SRS although I am in my RLE now. My wife divorced me, Her insurance covers GRS but now I am not covered unless I sign up for the Cobra at my cost (which I did). Since that Cobra covers 18 months and I need after care, I am rushing to get the GRS as soon as practical so that I don't incur incredible debt for something I am going to do anyway. While there are probably many reasons for rushing, knowing who we are and where we are going is the first real test. I agree that there may be some who aren't sure and should take a little time to reflect before the "snip/tuck" but for many, we already know who we are and don't need restrictions from someone else's opinion called the SoC. There is good check points in there for those that are unsure but I think IMHO that the burden of fulfilling the guidelines in the SoC restrict too many beyond reasonable and may even force their decisions to remain in the closet. Just sayin'

[Beth-Lock]

... I have seen a lot of people who wanted access to hormones and surgery NOW or they were going to give up on the whole thing! Most of them did. Transition is a waiting game, and if a person will stop the transition process because the wait is too much to bear, then they may not be trans after all. Finding that out after surgery can have dire consequences.

As someone else said the problem is when you are approaching the point where you are getting old, and your luck with your health is running out, you do have a sense of urgency, because you know it may be now or never. You are between a rock and a hard place.

Of course time is a great aid in finding out if you are truly ts to the point where GCS is indicated without a doubt. But, baring the development of better evaluation techniques that are faster, some of us do not have the luxury of taking the time to let this issue be sorted out. We need a decision now. It is a major dilemma and a Catch-22 isn't it?

Frances, I admire your posts and find them sensible. What bothers me is the lack of urgency some of the therapists, I admit, over booked, have when it comes to dealing with older TS like me. But then even if they had the time for intensive work with us, would their diagnostic and psychotherapy tools be adequate for doing the job of speeding things up? Probably not always.

[Aprilrain]

Of course time is a great aid in finding out if you are truly ts to the point where GCS is indicated without a doubt. But, baring the development of better evaluation techniques that are faster, some of us do not have the luxury of taking the time to let this issue be sorted out. We need a decision now. It is a major dilemma and a Catch-22 isn't it?


This indeed sounds like a real dilemma. I'm 35 and I feel a sense of urgency, one could be 20 and feel she has completely missed out on growing up as a girl. Every older person knows that young people don't have a clue how lucky they are LOL!

BUT heres the thing, it is not the job of a therapist to work out if you are TS or not!!! I don't feel that this can be emphasized enough. I you are going to a therapist with the expectation that you will be TOLD you are TS then watch out QUACK ALERT!!!
I would think any self preserving therapist would be very hesitant to suggest to a person who doesn't already know what they are that they are TS. I sought therapy cause this gender crap wouldn't leave me alone! I knew a lot before I ever went because I looked stuff up on the internet. I was already past the point of thinking there was a cure and I had a pretty good Idea of where I wanted to go but I guess I wanted to make sure I wasn't just crazy!

[Frances]

Money should not be a reason to speed up anything in my opinion. Ten months ago, an American had her surgery in Montreal and woke up to find out she did not feel like a woman, as she had expected. She went crazy and attacked the nurses and was put in a psychiatric clinic for suicide watch. She had went around the SoC and had bought her letters.

What are we talking about anyway, years or months? Where I live, one cannot change their gender marker without SRS, but it is not required to start living as a woman full-time, which is the real goal in my opinion. How long does hair removal take? I have been doing electrolysis and laser for over 5 years. Would you stop because it will take too long? Same thing with a college degree.

The hospital where I went for my transition is very strict about the SoC. They require a minimum of 2 years of weekly therapy with a 1-year RLE. They NEVER tell any patient/client that they are trans and NEVER recommend HRT or SRS, nor do they prevent the person from getting at these things. Their mission is helping the person explore their psyche and clean up shop (mentally). If the person still demands HRT or SRS after set periods of time they give it to them. Everyone that I know who gave up on transition or detransitioned, EVERYONE, thought the hospital's process was too long and arduous. Everyone that I know who went through this program to the end has transitioned and is well integrated into society.

What has age to do with it? Like Aprilrain says, you can be 20 and regret a lost childhood. I am 45 and I wish I were 35 like Aprilrain, but I know women who transitioned at 55 and 65. To me, and I could be wrong about this, the idea of it's now or never, raises major red flags. The problem is that there is that never is in the equation, which means that transition is optional. If transition is inevitable, on the other hand, what is the difference between 6 months or 18 months or, in my case, 5 years? It was going to happen anyway.

[Kaitlyn Michele]

i think its reasonable to let money in the equation...its a risk though...in the best case the SOC (imperfect as it is) should guide professionals and trans people, but should not be a decision maker..the decision maker is you, the person. it is your life..
when i have argued that it's my life, and here's what i am doing to everyone, its hard to argue against another person saying the same thing but doing something different than me..

that being said, the risk of getting caught up in the money is real.....money clouds judgement..
buying therapy letters is an extreme example.....so all one can say is going to fast is a risk...ignoring the SOC (Which hate it or love it is put together by a large group of experienced and caring people that know what they are talking about) seems foolish..

Waiting to be diagnosed is a personal issue...i hate the whole concept of being "diagnosed".. but i love the idea of communicating your experience, and comparing it to others...and being honest with yourself..
it think in your case beth it is in your hands more than you think....

i agree at your age this is a charged issue...stand up for yourself...analyze yourself.. you know the SOC, you can read all the docs, it is YOUR sense of urgency and your life...
if you are expressing this urgency with no satisfaction, move on...nobody says this easy...but if you are ts and you aggressively make progress your rewards will be high...if you don't feel rewarded, its time to step back, its not a therapy issue...

[HenryHall]

... Waiting to be diagnosed is a personal issue...i hate the whole concept of being "diagnosed".. but i love the idea of communicating your experience, and comparing it to others...and being honest with yourself..
it think in your case beth it is in your hands more than you think.... ...
The SOC is inherently a medical document, it contains the texts

... Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available.
...
... The criteria for hormone therapy are as follows:
1. Persistent, well-documented gender dysphoria; ...
...
Criteria for mastectomy and creation of a male chest in FtM patients:
1. Persistent, well-documented gender dysphoria ...
...
Criteria for breast augmentation (implants/lipofilling) in MtF patients:
1. Persistent, well-documented gender dysphoria ...
... and so on for hysterectomy,ovariectomy, orchiectomy metoidioplasty, phalloplasty and vaginoplasty ... {emphasis was added}

Thus, the SOC is crystal clear, for these treatments Gender Dysphoria is not only required to be diagnosed, but required to also have a documented history. Diagnosed as Gender Dysphoria. And, as the SOC later asserts, Gender Dysphoria can only be diagnosed and documented by mental health professionals with documented credentials. Crucially, there is no "diagnosed" (scare quotes) about it.

The alternative is to dump the SOC and treat the mental health part of the "... transgender, transsexual journey ... " as a matter of human rights rather than as a medical issue. To be blunt, the unpleasant implication is that, through their gatekeeping antics, some psychologists have made themselves untrustworthy. The European Parliament sees it that way, but doubtless there are "experts" who will assert contrariwise. {scare quotes intended}
See Paragraph 13 of Recent European Parliament resolution (http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA-2011-0427+0+DOC+XML+V0//EN&language=EN)
http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA-2011-0427+0+DOC+XML+V0//EN&language=EN

[Starling]

Because of the last decade's rapid expansion of TS awareness--and advocacy for insurance coverage--the counseling talent right now may be pretty thin on the ground. Fortunately, I'm mightily impressed with the "non-directiveness" of my gender therapist. I guess her thirty years of experience and education count for something.

:) Lallie

[Melody Moore]

Wow, some people here really just don't get it with the SoC and like to twist things around to suit their own agenda - sad :(

[Beth-Lock]

My case has been dragging on for six years...

As for the RLE, I am past two and a half years of living as a woman full-time. (I was dressing as a woman a lot of the time, though more discreetly for some time before that, and certainly within the home full-time, but I am not counting that.) Doing it full-time everywhere was a decision I took myself, being frustrated by the professionals. I have not regretted that, and am adjusting better and better, to life as a woman. I even belong to a women's group. Luckily I could pass well enough without the aid of FFS or the feminizing effect of hormones which I have never taken, again not by choice. A lot of trans can't pass like that, so I have been fortunate to have had the option.

I am not really complaining, but thought this might clear up some misconceptions about where I am coming from. I talked to another transwoman here who did get SRS, and she had to wait too long as well, and got it late in life. The situation here is we are poorly served as far as trans go, and I am not the only one to observe that. A friend was trying to get someone to set up a trans clinic here, but it never materialized. For a conurbation like ours of about a million people, that is a shame. (At the rate of one in a thousand, that means we have about a thousand of us here.)

[Fractured]

Wow, some people here really just don't get it with the SoC and like to twist things around to suit their own agenda - sad :(

Everyone has an agenda. I would be surprised if everyone believed the same thing, had the same perspective, and had the same goals. By taking everyone's perspective into account, particularly dissenting ones, we can learn more about the world around us. I would hate to disregard valid considerations and stances. Group-think has led to many bad situations.

I can understand and empathize with someone's viewpoint even if I don't agree with it. Just because I hold a different perspective from them does not invalidate their points nor does it mean mine are more (or less) valid.

And so far, I really haven't seen any true disagreements in this discussion. It seems more that everyone has a different take on the discussion and are arguing on separate points that have yet to truly conflict. The biggest sticking point seems to be the "need" to have an enforced SOC that requires the "intervention" of mental health professionals to allow HRT and SRS/GRS. One side is arguing the SOC is good for providing structure and assurances while the other side argues that mental health professionals can be blockers since it requires a diagnosis of mental disorder (an anathema to a sane person) and support (via letters) to allow "treatment" (and that there are those professionals who will not provide such based on personal beliefs/opinions).

The side discussion on cost of care and the health system through which it is provided seems just that, a side issue to the main discussion.

Is that an accurate assessment of the debate thus far?

[HenryHall]

Everyone has an agenda. ...
Is that an accurate assessment of the debate thus far?
It's an excellent essay précis and it is substantially more right than wrong.

You might add that some hold that the SOC fails to comply with international agreements and treaties on human rights. UDHR(1948) and more specifically ECHR(1953).

[Kaitlyn Michele]

Luckily for me the SOC and WPATH didn't stop me.
nobodies agenda was gonna stop me..words on a piece of paper didnt impact my fundamental human rights..

I took personal responsibility for my life and my identity. And i help others to do so now.

There are so many helpful people out there, you have to find them. If you can't, its on you. If you let the SOC stop your transition, its on you.
If you don't have the money for transition, it's on you. If you are afraid of the gatekeepers, it's on you.
Feel free to blame others, its your life..

There are no easy solutions...but its not somebody elses fault if you are stuck...read the SOC..its a good document...understand how it relates to you...talk to other transsexuals...learn from them ...know the medical implications, find a supportive doctor, there are tons of them...get unstuck..work with it or work around it, whatever suits your personal situation...but be smart and don't get caught up in how you don't like words on a piece of paper.

[Melody Moore]

There are no easy solutions...but its not somebody elses fault if you are stuck...read the SOC..its a good document...understand how it relates to you...talk to other transsexuals...learn from them ...know the medical implications, find a supportive doctor, there are tons of them...get unstuck..work with it or work around it, whatever suits your personal situation...but be smart and don't get caught up in how you don't like words on a piece of paper.
Thank you Kaitlyn - some people here forget that the SoC are only guidelines that health professionals are working with
and this is why I have an issue with Henry's outlook of the SoC here. Personally I think Henry doesn't like the new SoC
because it doesn't fit his personal agenda. And according to him it doesn't comply with the ECHR(1953)? You really have
got to be kidding me. Poor Henry does not feel the SoC are fair and equal to all? FFS!

http://a2.sphotos.ak.fbcdn.net/hphotos-ak-ash4/307357_231103003609960_100001307869149_597790_3335 06904_n.jpg

[Fractured]

I will admit that, as a citizen of the US, I am not as versed in international law as some of ya'll are. I did a quick read through the UHDR and a glance over the ECHR (which as a European document has no authority in my country) description on Wikipedia and in that admittedly brief review I found little to nothing specifically calling out medical coverage as a right (or anything else I could conceive being related to the SoC). Granted, courts can say a provision covers a certain case (such as the US Constitution not calling out protection of reasonable expectations of privacy but the US Supreme Court has ruled that it does) so the fact that something isn't specifically stated may not mean much.

That aside, for me personally, I like the SoC. It provide a framework that I can understand when my healthcare providers say they adhere to it. It provide a structure I can fall back on to say that a minimum amount of reasonable effort was made to make sure that transition is the right course for me. And I acknowledge that others may not want to adhere to them, so I don't expect them to. It is their right not to do so.

[HenryHall]

... the SoC are only guidelines that health professionals are working with and this is why I have an issue with Henry's outlook of the SoC ...
And according to him it doesn't comply with the ECHR(1953)?
I agree that you have an issue with my outlook.

Let us agree to differ as to whether the SOC complies with ECHR(1953). I find it sufficient the the European Council (47 nations) and the European Parliament (27 nations) have recently (in the last 90 days) passed resolutions that take my side.

Big girl panties notwithstanding.

[Beth-Lock]

I think it is more signifcant than many give credit, that the new standards would accept gender correction surgery without hormone administration. Physically, this of course might be problematic, but used to be the way it was done originally.

[Kaitlyn Michele]

I think it is more signifcant than many give credit, that the new standards would accept gender correction surgery without hormone administration. Physically, this of course might be problematic, but used to be the way it was done originally.

I didn't know that Beth..that's pretty interesting...i do know that years ago they based decisions around transition on how you looked...
i would have never passed muster back then...too tall...next...

it is interesting that regardless of how its viewed today, it has changed alot over the years, and will possibly change alot in the future..