breast augmentation

[kathyLB]

Traci E. since you are SC the surgeon that i foundto do my breast aug said he had to find out the legality of doing my breast aug. what is your opinion or do you know anything on the matter ;thanks;

[Traci Elizabeth]

Traci E. since you are SC the surgeon that i foundto do my breast aug said he had to find out the legality of doing my breast aug. what is your opinion or do you know anything on the matter ;thanks;



Unfortunately, I do not know anything about having BA as my breasts have grown to a 36C on HRT alone. But I can understand your doctor's hesitation if you are wanting the BA just to have female breasts. I would think a letter from your Psychiatrist would alleviate any concerns your doctor has.

[Melody Moore]

I read your other post here where you seem pretty keen to pursue this idea of having Breast Augmentation
surgery and without seeing a therapist or even being on hormones if I am to understand you correctly, yeah?

>>> http://www.crossdressers.com/forums/showthread.php?178561-hormones-therapist


went to my family doctor about hormones, told him about talking to a surgeon about breast implants my GP wants to know if the surgeon thinks I need a therapist, I don't think so, going to have implants, hoping in about 30 days

Personally I think you might be making a big mistake and you might find it very hard to get breast augmentation based on some
type of informed consent model given what I know so far about your background & issues you are having with coming out your son.

So I think a therapist should be high on your agenda to be honest. Just my thoughts.

[Raquel June]

Now, I'm going to agree that the vast majority of us could use a good therapist (if only to vent). But the OP sounds like she has her mind made up, and she's almost 70. If she wants a boob job then she should probably be able to get one. I doubt she'll be full of regret in five years.

I mean, if this guy can get a boob job on a bet...

http://en.wikipedia.org/wiki/Brian_Zembic

When we are secure in our feelings we shouldn't have to pander to various gatekeepers to get permission to do what we want with our bodies.

[Stephanie-L]

It is not hard to find a plastic surgeon who will do a BA for you, no letters, no hormones, just cash. There is no law about it, and they don't have to follow any recomendations from someplace like WPATH, and that is all they are, recomendations, not rules. Most docs with a large trans patient base will follow them however. The biggest thing I see is that they can only go so large if you have no breast tissue to start with, so going on hormones for a while allows some growth and allows you to go larger. Yes, you can go back and "upgrade" in a year or two, but that is a hassle. Several years ago, before I started transition in earnest, I consulted a plastic surgeon about a BA, he was ready to do it, just pay first. But he could only get me to a B cup. I am glad I waited, I now have almost A cups and will probably be able to go at least a C, maybe a D when I get mine next year. Good luck to you............Stephanie

[noeleena]

Hi,

Here it is not a issue all you need do is see a Pysch just to make sure your of sound mind get your letter then see a surgeon .

no probs in Thailand it was done , again no ? as to my self.i did have other surgerys as well. & b a would not be ? nd,

What i would ? is why you feel you need this do you have any health issues body wise. how much spare skin do you have around you breasts now , as going on hormones does help to allow your breasts to grow not the same as a womans of cause as our bodys are different.

if you do need to go this way id check the hormone road first as that would be far better for you in the long term.

do have a talk with your G P or a woman who will have a better understanding of this concern. if you do then do your blood tests so you have a base count to work on health wise .
before trying any hormones.


...noeleena...

[Raquel June]

The biggest thing I see is that they can only go so large if you have no breast tissue to start with, so going on hormones for a while allows some growth and allows you to go larger.


if you do need to go this way id check the hormone road first as that would be far better for you in the long term.

I know everybody's just trying to be helpful/thoughtful/whatever, but what exactly is to be gained by her going on HRT? She's 20 years past menopause and she has expressed no interest in it. But she's supposed to block that little bit of testosterone that's left so she can get osteoporosis?

How many years do you think a 69-year-old should spend on estrogen before getting a boob job? She's very unlikely to see significant development, especially given that most doctors are going to give you a really weak dose because of the higher DVT risk. And I'll bet she's got enough skin.

But what if she did try to go the HRT route? Well, then she has to go see a shrink for awhile. How long? A few months? A year? Who knows? Then what should she do? Take estrogen for six months and see what happens? And then if nothing happens, what, try for a year?

I'm just saying that if she wants a boob job there's nothing illegal about getting a boob job and she should be able to find a doctor to do it. If she has her mind made up then there's just no legitimate reason to put it off.

[Melody Moore]

Raquel, there is obviously MANY issues this person has not yet addressed, like coming out to their son about there CDing.

You can't exactly hide boobs once you have them and obviously this person has not considered the ramifications of that yet.
So that is why I think this person SHOULD be seeing a therapist before going anywhere near a surgeon. If I was the surgeon
no way would I agree to do it because even with informed consent this person could still turn around later and sue the surgeon
for their own bad decision if the surgeon did not cover their arse and get a psychologist assessment done first. Trust me, it
does happen and that is why there are so many checks put in place now by gatekeepers.

[kellycan27]

Men can get peck implants, so I don't see why they shouldn't be able to get B/A .. just saying. I'll leave my opinion about the wisdom of doing it to myself. From what I have read it's not a legal issue at least here in the USA. I don't know any GG's that have had to get a psych assessment before going about getting implants. I didn't have to show any kind of evaluation before I got mine. The OP asked if it was legal, and not for personal opinions of why one shouldn't from assistant gate keepers. :heehee:

[Raquel June]

If I was the surgeon no way would I agree to do it because even with informed consent this person could still turn around later and sue the surgeon for their own bad decision if the surgeon did not cover their arse and get a psychologist assessment done first. Trust me, it does happen and that is why there are so many checks put in place now by gatekeepers.

Really? Got an example of a single time when that actually did happen?

Laser hair removal is permanent. Should we all need notes from our therapists to get it? And maybe a signed form from all living family members stating that we came out to them?

Maybe people should see therapists before getting tattoos. But where do you draw the line? Is getting your ears pierced too girly? Maybe that should require a note, too. Maybe we should all need notes before we can buy women's clothes.

Maybe Michael Jackson and Joan Rivers should've gotten more therapy before they got a ton of plastic surgery. But thank God we are free to do stupid stuff without paying for advice from a professional.

I've got boobs and I don't know how to talk about my gender issues with my parents. Should I get a double mastectomy until I figure out what to say?

Seriously, where do you draw the line on our right to our own body?

Getting a vag carved into you is a touchy subject in many ways because you can change legal documents -- and you are irreversibly sterilizing yourself. But a boob job is purely cosmetic, and if women are allowed to get boob jobs then we should be able to get boob jobs and we should never need someone's stamp of approval that we're "trans enough" to do it.

Do you need to prove you're cisgendered for anything? Gatekeepers do not help our cause.

[Eryn]

Janet, the owner of Janet's closet talks about getting her implants here:

http://www.janetscloset.com/breast_implants.htm

[Melody Moore]

Really? Got an example of a single time when that actually did happen?

Haha, are you serious? There has been lots of incidents where doctors have been sued for
performing surgery on people who were not suitable. In fact the Monash Gender Centre in
Melbourne was shut down a few years ago because they bent a few rules and allowed the
wrong people to have surgery. So don't even get me started on this. Just read this as it
is highlights the fact that surgeons take a lot of convincing because of the potential litigation.


Janet, the owner of Janet's closet talks about getting her implants here:

http://www.janetscloset.com/breast_implants.htm
Thank you, this story highlights how surgeons are concerned and will not proceed with surgery if they are
not satisfied the person is out and completely comfortable about who they are with others around them.

The OP is not even out with their son yet and until such time as they are, there is going to be a reluctance
by surgeons to perform the surgery. This is something I have talked about already with a number of service
providers in discussing 'informed consent' models for surgery etc. There are standards of care and if they go
against them, it can be argued the doctor went against recommendations & they can be sued for malpractice.

[Cindi Johnson]

Raquel wrote: "When we are secure in our feelings we shouldn't have to pander to various gatekeepers to get permission to do what we want with our bodies. "

To which, I say AMEN!.

Others, those not TG, are allowed to do what they choose as long as it hurts no one else. Drink too much? No problem, pour another. Risk your life climbing Denali? Hey, it's your life, after all. In Western countries, adults are presumed to be sane unless facts clearly show otherwise. That's why we're called adults, after all.

But here in TG-Land, all seem to agree as fact that we must have a therapist decide everything with us. My God! Cannot a girl decide something on her own?

Raquel, your thoughts are indeed a much needed breath of fresh air.

[Traci Elizabeth]

Raquel wrote: "When we are secure in our feelings we shouldn't have to pander to various gatekeepers to get permission to do what we want with our bodies. "

To which, I say AMEN!.

But here in TG-Land, all seem to agree as fact that we must have a therapist decide everything with us. My God! Cannot a girl decide something on her own?

Raquel, your thoughts are indeed a much needed breath of fresh air.



What you fail to see or understand is that some individuals who claim to be "normal" and able to make their own decisions are in fact far from normal, and they don't even realize it. You don't have to look far to find some here and on the news. I can think one "orange" colored hair individual in Colorado just off the top of my head. There are also those who convince themselves that they "must be" TS so they opt for surgeries only to realize that made a big mistake, and that in fact they are NOT TS.

But your remark that you as an adult can do what you want is not founded in reality. Try for example to have SRS by walking into a surgeon's office demanding a vagina. Good luck getting one without a shrinks approval. Your whole life is dictated by rules, regulations, laws, requirements, etc. So you really think that as an adult you have complete freedom to do as you please?

[Melody Moore]

all seem to agree as fact that we must have a therapist decide everything with us.

Wrong, a therapist never makes these decisions for you, what they do is work with you to ensure that you
dont have any emotional or mental health issues that have not been addressed. And in the case of the OP
there are a few issues that I can see that need to be addressed long before they even think about breast
augmentation and the biggest issue is with coming out to their son. How do you or the OP know that the
son won't react badly to the OP who ends up regretting getting implants and now wants them removed?

Who will pay for that or will this person turn around and demand the surgeon does it for free and sues them
as well because the surgeon didn't follow protocol? I would gladly slam the door in the face of anyone if I was
a surgeon if they came to me making these types of demands and sadly that is how some surgeons are because
of delusional people who think they want to have breasts, vagina and be a woman. There is a lot more to being
a woman than that I assure you. So get use to it.

Traci, I like how some people here seem to know all about gender therapist when it is
blatantly obvious they have never seen one to have any idea about how they work. LOL

[DebbieL]

Melody is correct. There are hundreds of good reasons for coordinating medical changes with gender transition therapy with a Licensed Social Worker, Psychologist, or professional counselor. I started the transition process, and my therapist gave me hundreds of great assignments, and helped me to address a number of issues that came up. I reached the point where I was living as a woman from 6PM to 7 AM - from when I got home from work to when I left for work, and under-dressed while at the office. I had a community that supported me, and several housemates who supported me.

It was only when my wife threatened to have the judge order supervised visitation (as their father) that I had to stop the process. It was either give up the transition or give up my children, and I had concerns about their step-father, so I needed to be able to step in if necessary.

Ironically, ENDING a transition process ALSO requires a lot of therapy, sometimes even MORE therapy, since there is a much higher risk of suicide or self-destructive behavior if you are a transsexual and have to face the reality of living the rest of your life as a woman trapped in a man's body. The suicide rate among transsexuals is incredibly high, especially among teens. I should be dead 20 times over, but somehow I survived. I had two cousins who did kill themselves.

This is the real reason surgeons are so cautious about doing radical surgeries such as breast augmentation. Too often, when someone takes shortcuts, they end up getting the dramatic change, but since they haven't done the other prep work, dealt with the consequences of transition, and haven't created an environment that supports them as women. They get the boob job, but they still can't really pass, they still grow shadows, they still don't act like women, and they get read and harassed. If they commit suicide, it's usually the family, often the family that rejected them, that is trying to sue the doctor for malpractice.

[Melody Moore]

Not unless informed consent is somehow legislated into law like they did recently in Argentina with their
trans health reforms, doctors will have to stick within the WPATH guidelines or they risk being sued and
this is why there is reluctance amongst surgeons and medical practitioners to deal with trans clients.

[NCAmazon]

I know several trans girls and even Drag queen males who got BAs in the USA without any letters or consent forms from a therapist. They basically just had to fill out a form and waiver that they understood the risks and approve the surgery. That simple. These are also well known surgeons.

The doctor's just want to make sure you are serious about the surgery and implants. Simple.

[Raquel June]

Haha, are you serious? There has been lots of incidents where doctors have been sued for
performing surgery on people who were not suitable. In fact the Monash Gender Centre in
Melbourne was shut down a few years ago because they bent a few rules and allowed the
wrong people to have surgery. So don't even get me started on this. Just read this as it
is highlights the fact that surgeons take a lot of convincing because of the potential litigation.

Yes, I'm serious. You implied that people had been sued for giving breast augmentation to genetic males. I asked you for an example because I have never heard of that happening.

I understand what you're saying, and I understand that you represent most people's feelings. And you're right -- doctors have to be very careful. And I also agree that most of us could use therapy -- because transition is such a major life change that you need all the help you can get.

But in itself, needing permission to get surgery is just not something I can support. Simply on the principal of "my body my choice," and the fact that no GG needs a note from a therapist to get a boob job.



But here in TG-Land, all seem to agree as fact that we must have a therapist decide everything with us. My God! Cannot a girl decide something on her own?

Exactly. It's just that I think we've all been through a lot, and especially if we transition we could all use a really good therapist. Probably years of therapy. But I absolutely hate the precedent of actually needing permission from that therapist. That can't possibly be good.

What's the downside of not needing a therapist's approval? Just think about it! Is it that non-trans people will get surgery? Who cares? If you're that crazy, your downfall isn't going to be a boob job. You'll no doubt find something much more self-destructive.

And regardless, these rules fall under the category of things that are done with good intentions that only inconvenience people. If the rule is that you need a therapist's approval, then you'll be able to shop around for a therapist to give it to you. So it does no good. It's like needing a doctor's permission to get a card that says you can smoke weed. Have you seen the "doctors" selling marijuana cards on Venice Beach?

Anyway, I'm just honestly horrified that so many people think it's good that someone else decides for us whether or not we're transsexual.



But your remark that you as an adult can do what you want is not founded in reality. Try for example to have SRS by walking into a surgeon's office demanding a vagina. Good luck getting one without a shrinks approval. Your whole life is dictated by rules, regulations, laws, requirements, etc. So you really think that as an adult you have complete freedom to do as you please?

Wow. Those are some shocking statements from someone who claims to be politically on the far right. I guess we should take away all your guns until you can prove to a therapist that you don't have any hateful thoughts.



I know several trans girls and even Drag queen males who got BAs in the USA without any letters or consent forms from a therapist. They basically just had to fill out a form and waiver that they understood the risks and approve the surgery. That simple. These are also well known surgeons.

The doctor's just want to make sure you are serious about the surgery and implants. Simple.

Exactly. I also have met several drag queens (even several in Ohio) who got boob jobs, and a few identify more as gay than as trans.

It's scary the direction this thread has gone -- people shouting that we need to be policed and saved from ourselves. But the fact is that it's pretty easy to get a boob job, even for the guy I posted the link to who got a boob job on a bet and never claimed to be even slightly TG.

[Kristy_K]

My therapist had also said there is no letters require for a BA or a FFS in the US. Now if it was being paid for by your insurance company then they could require a letters from your therapists as they do for a SRS.

[kellycan27]

My therapist had also said there is no letters require for a BA or a FFS in the US. Now if it was being paid for by your insurance company then they could require a letters from your therapists as they do for a SRS.

Except for the fact that insurance companies don't normally cover cosmetic surgery if at all. I don't think a B/A would be considered done for health reasons.

[Kristy_K]

Except for the fact that insurance companies don't normally cover cosmetic surgery if at all. I don't think a B/A would be considered done for health reasons.

Believe it or not as of this year my insurance covers all of the steps in transitioning including BA, FFS, SRS and some electrolysis. Getting them to honor their plan has not been easy because it is all new to them and they are not for sure on how to provide the coverage. It has been a very long and hard fight. But it will help other people who transition in the future.

Dr. Marci Bowers accepts Bluecross Bluesheild now. They are working with my insurance to get my SRS scheduled. I am in hopes of hearing something within the next few weeks.

Now it does goes to show that some company's are starting recognize the important aspects of the TS. I hope there will be more company's that will follow suit.

[kellycan27]

Believe it or not as of this year my insurance covers all of the steps in transitioning including BA, FFS, SRS and some electrolysis. Getting them to honor their plan has not been easy because it is all new to them and they are not for sure on how to provide the coverage. It has been a very long and hard fight. But it will help other people who transition in the future.

Dr. Marci Bowers accepts Bluecross Bluesheild now. They are working with my insurance to get my SRS scheduled. I am in hopes of hearing something within the next few weeks.

Now it does goes to show that some company's are starting recognize the important aspects of the TS. I hope there will be more company's that will follow suit.

As i stated earlier "most" insurance will not cover cosmetic procedures. Your case if anything is the exception, not the rule.

[jackielou]

hello kathy what size breast implants are you wanting and have you worn a bra with forms the size you want to be out in public to get reactions i have large breast and have never had any problems i get a lot of looks and stairs mostly from women who smile and speak

[pamela_a]

As has been already been stated, people who are considered 'normal' aren't required to jump through all of those hoops because they are normal and think clearly. Transsexuals are NOT normal and not able to think clearly as evidenced by their desire to go against all societal sense and 'the laws of nature" and change their gender. As a result they must, as my love so perfectly put's it, go to a therapist and get letters to prove they are "crazy enough to be a woman".

I can understand those who are not sure of themselves or having other issues the need to have someone "approve" their choices. But the idea everyone needs to have someone else's approval is something I've always found offensive and demeaning.

What happened before the WPATH "guidelines" (read unbendable rules by too many) existed? Were those pioneer transitioners turned away at the surgeon's door because he wanted a letter? Did people have procedures done then later regretted them? I'm sure they did. But then if you talk to any cosmetic surgeon who has been practicing for any length of time, I'd be willing to bet they could identify at least 1 patient they had that regretted getting something done. Does that mean they should require their patients get a therapist "stamp of approval" before they do anything?

I can understand procedures covered by insurance companies can have more specific requirements. Thankfully, according to the HRC, there are more and more companies that have started to add that coverage. I'm afraid with the new "healhcare" law that will be going into effect in a few years that will soon all go away and we'll be back to fending for ourselves... but that's a completely different topic.

To the OP:
Go for it. Live YOUR life. You've more than reached the age of majority. My only caveat is be prepared for the repercussions of your decision. Like most other things in life. Just because you are 'free' to do something doesn't make you immune to everyone else's freedom to react to it.

[Badtranny]

This is an interesting thread.

I believe I am on record as supporting therapy as well as medical supervision before and during transition. Having said that, I've never been comfortable with the idea that I need someone's permission to alter my body. I believe the whole idea of a letter and RLE before allowing SRS is founded in the skittishness of male doctors who are uncomfortable with the whole concept of losing their penises. What is so awful about becoming a woman that they want to put up roadblocks? I think the TS community supports the hoops because they have a measure of pride that they themselves were "accepted" and made it through the process. Personally, I think a dude should be allowed to get a boob implanted in his forehead if that's what he wants. Or three boobs instead of two. Why should women be allowed to get enormous breasts installed with no questions asked but a man has to navigate a bureaucratic maze for a simple enhancement? What is so bad about a man wanting to look feminine?

What about that woman who wanted to look like a cat? What about those people who bedazzle their faces? What about face tattoos? What about those horns that some people get put in their heads. I saw a picture of a man and a woman who had piercings up their back that they actually put laces in like a girdle. What about that guy in the Guinness book that has the worlds smallest waist due to corset training?

People are crazy, but who cares. I saw a therapist because I wanted to. I got an HRT letter from her because I wanted one. My doctor never asked and it turns out he doesn't even require them. He specializes in Trans people and his opinion is the majority of people he sees about trans issues are indeed trans. The few that are not still deserve decent medical care and he doesn't want to leave them to self medicate. People are crazy right?

I didn't need a letter for my Orchi and I didn't need a letter for my BA. I knew what I wanted and I'm extremely happy with the result. It's my body, and my business. Anybody that tries to keep me from doing anything with my body is gonna have a fight on their hands. I'm the type of person that will get boobs even if I don't want them just to prove that you're not the boss of me. ;-)

[Jorja]

This is an interesting thread.

I believe I am on record as supporting therapy as well as medical supervision before and during transition. Having said that, I've never been comfortable with the idea that I need someone's permission to alter my body. I believe the whole idea of a letter and RLE before allowing SRS is founded in the skittishness of male doctors who are uncomfortable with the whole concept of losing their penises. What is so awful about becoming a woman that they want to put up roadblocks? I think the TS community supports the hoops because they have a measure of pride that they themselves were "accepted" and made it through the process. Personally, I think a dude should be allowed to get a boob implanted in his forehead if that's what he wants. Or three boobs instead of two. Why should women be allowed to get enormous breasts installed with no questions asked but a man has to navigate a bureaucratic maze for a simple enhancement? What is so bad about a man wanting to look feminine?

What about that woman who wanted to look like a cat? What about those people who bedazzle their faces? What about face tattoos? What about those horns that some people get put in their heads. I saw a picture of a man and a woman who had piercings up their back that they actually put laces in like a girdle. What about that guy in the Guinness book that has the worlds smallest waist due to corset training?

People are crazy, but who cares. I saw a therapist because I wanted to. I got an HRT letter from her because I wanted one. My doctor never asked and it turns out he doesn't even require them. He specializes in Trans people and his opinion is the majority of people he sees about trans issues are indeed trans. The few that are not still deserve decent medical care and he doesn't want to leave them to self medicate. People are crazy right?

I didn't need a letter for my Orchi and I didn't need a letter for my BA. I knew what I wanted and I'm extremely happy with the result. It's my body, and my business. Anybody that tries to keep me from doing anything with my body is gonna have a fight on their hands. I'm the type of person that will get boobs even if I don't want them just to prove that you're not the boss of me. ;-)

But guess what? Your going to need letters if you expect to get SRS anytime soon.

[pamela_a]

But guess what? Your going to need letters if you expect to get SRS anytime soon.

And therein lies the problem. Why do we NEED someone else's approval? These seem to be rules written by men who either can't fathom the idea of getting rid of their penis and/or their ever present desire to control everyone else's life.

I'm reminded of the line from the song Sunshine by Jonathan Edwards. "He can't even run his own life, I'll be damned if he'll run mine"..

[Jorja]

And therein lies the problem. Why do we NEED someone else's approval? These seem to be rules written by men who either can't fathom the idea of getting rid of their penis and/or their ever present desire to control everyone else's life.

I'm reminded of the line from the song Sunshine by Jonathan Edwards. "He can't even run his own life, I'll be damned if he'll run mine"..

Your preaching to the choir. What remains is the fact it ain't happening with out permission. If you want change you need to initiate change.

If you take time to look, a lot of these "rules and regulations" have been eased in the latest version of WPATH. Its not going to happen overnight.

[Bree-asaurus]

I can understand those who are not sure of themselves or having other issues the need to have someone "approve" their choices. But the idea everyone needs to have someone else's approval is something I've always found offensive and demeaning.

Well... you can't really have both. If someone is unsure of themselves, are just in some sort of 'pink fog,' and have temporarily convinced themselves that they are prepared for some radical surgery, we can't somehow split them from the rest of the transsexuals who don't need therapy or 'approval.' Even with our system that 'requires' all this proof and letters of recommendation, people still fall through the cracks.

And where do we draw the line? Is SRS, BA or FFS for transsexuals medically necessary or elective? Can they be a combination of the two? Can our health care system evolve to consider SRS medically necessary, cover the expense like they would for other surgeries that effect a person's health, but still let anybody get the surgeries without any kind of approval process?

[ClassyOne]

This is one of many great discussions. As I get started, I had not thought about needing much cleavage but when the clothes arrived I realized that a woman's sweater has extra space in certain places that I now need to think about. Good luck to all those who have been here long before me and thanks so much for sharing your stories of promise to those like me. Love ya all.

[Frances]

Can our health care system evolve to consider SRS medically necessary, cover the expense like they would for other surgeries that effect a person's health, but still let anybody get the surgeries without any kind of approval process?

I don't believe so. From having sat on discussion panels including members of the WPATH, I can assure you that their intention is not blocking as many people as possible from accessing medical care. Quite the opposite, they want to make it easier for people who do "need it" to get it. The point of the SoC is maximizing the chances of success and minimizing the possibilities of regret. Once in while, I do meet people who wish they were transsexual and would regret surgeries and other body transformations. If one sees transsexuality on equal footing as piercings and other body modifications, then maybe there should be unethical doctors to do the deed for money.

Here's the kicker: most trans people DO NOT want to be trans. DO NOT want to get their penises inverted. DO NOT want to have bigger breast, but must do all these things to keep on living.

I see no problem with transsexuality being viewed as an orphan disease requiring medical intervention, so I am all for removal from the DSM as a mental disorder, but if trans people want the state to pay for treatments, then a little gatekeeping is just fine.

[Bree-asaurus]

I don't believe so. From having sat on discussion panels including members of the WPATH, I can assure you that their intention is not blocking as many people as possible from accessing medical care. Quite the opposite, they want to make it easier for people who do "need it" to get it. The point of the SoC is maximizing the chances of success and minimizing the possibilities of regret. Once in while, I do meet people who wish they were transsexual and would regret surgeries and other body transformations. If one sees transsexuality on equal footing as piercings and other body modifications, then maybe there should be unethical doctors to do the deed for money.

Here's the kicker: most trans people DO NOT want to be trans. DO NOT want to get their penises inverted. DO NOT want to have bigger breast, but must do all these things to keep on living.

I see no problem with transsexuality being viewed as an orphan disease requiring medical intervention, so I am all for removal from the DSM as a mental disorder, but if trans people want the state to pay for treatments, then a little gatekeeping is just fine.

I think we're on the same page. I didn't mind having to go through the motions once I had everything figured out. I know who I am and have nothing to hide, so I really have no problem 'proving' myself to a therapist, etc. I would have no problem getting doctor/therapist/whatever verification that surgery is warranted if my expensive *** health insurance would cover it!

And I'm totally not saying that everyone needs therapy or letters of recommendation to proceed down the path of transition... I just think it's a minor issue that I really have no problem with, especially considering that it's such a small part of transition.

Then again, I also think that if you have the money, you should be able to do whatever the heck you want with it. If you can afford SRS or a BA and you want it, you should be able to get it. And if you're stupid enough to get it without being prepared, it's on you to live with your decision.

[Beth-Lock]

I see no problem with transsexuality being viewed as an orphan disease requiring medical intervention, so I am all for removal from the DSM as a mental disorder, but if trans people want the state to pay for treatments, then a little gatekeeping is just fine.

Medicare coverage always is incomplete anyway. Though SRS/GCS is covered by the government plan in Ontario, counselling beforehand, may not be fully covered, and post-op aftercare may not be fully covered either. My counselling fees would, at today's prices have cost me at least $4,500 (while medicare paid about $7,200 as well). Aftercare was about $4,000 for me to pay, and $300-400 for the government to pay. Transition related trips to the family doctor paid by the government would have to be added, as well as most but not all medical lab tests paid by the government, and about $100-$150 by me.

This does not include HRT, BA, FFS or hair removal. Nina Arsenault has spent a six figure sum on feminization surgeries without getting SRS/GCS or HRT, and likely has more ahead. I have also not included any prescription drugs, (to control/suppress male hormones). Then ther retravel expenses.

Today, all signs point to more costs being shifted to the individual or to private plans, and away from government funding. This means that predicting more generous coverage in the future for trans, seems blindly optimistic. Adding BA to insurance coverage where it is not covered now, would seem to be about the lowest prioriy imaginable.

P.S. An earlier thread here discussed how a non-trans US gambler making a bet he would not have BA and keep it for a year, obtained implant surgery for even such a frivolous reason. I did not know it got into the Wikipedia too, but then most recent things do it seems.


Why do we NEED someone else's approval? These seem to be rules written by men who either can't fathom the idea of getting rid of their penis and/or their ever present desire to control everyone else's life.

Perhaps because some people are plain crazy, and would change their mind after taking some medication for a while. They should not be sold dynamite either. That is how I think of it, though Pamela seems to express it the other way around.


How many years do you think a 69-year-old should spend on estrogen before getting a boob job? She's very unlikely to see significant development, especially given that most doctors are going to give you a really weak dose because of the higher DVT risk.

That is interesting. I shall have to quiz a 70+ year old trans I know, to see how significant her breast growth was on HRT so late in life.

[CharleneT]

And, that raises the question of how much it might cost.


Breast implants can be expensive! A young transwoman might need to pay $92,000, I figure. This is based on renewal every five years, from age 20 to 80, although this is of course, a pessimal estimate.

. . .


Hey, I'm curious, where did you find that breast implants need to be renewed every 5 years ? Most of the Mentor brand implants used in the US are expected to last 10 years or more. The Mentor implants I have carry a 20 yr guarantee (they are used in many countries, but not the US). My surgeon suggested they would likely last longer, not sure I believe that but it would be fine with me ;)

[Frances]

Hey, I'm curious, where did you find that breast implants need to be renewed every 5 years ? Most of the Mentor brand implants used in the US are expected to last 10 years or more. The Mentor implants I have carry a 20 yr guarantee (they are used in many countries, but not the US). My surgeon suggested they would likely last longer, not sure I believe that but it would be fine with me ;)

I know a few women who have their implants for over 20 years. I don't anyone who had to change their implants yet. No one. It may happen, but it's not a given.

[Raquel June]

I guess if your insurance is going to cover surgery because you're trans -- which would be awesome -- I can understand them wanting a letter from your therapist. Otherwise it might be kinda easy for non-trans people to play them and get free nose jobs, then they'd end up canceling all cosmetic coverage.

But that's the point, really. For trans people it's not exactly cosmetic procedures. If I need SRS to change my driver's license to say F, that is far more than a cosmetic procedure. Although for that, at least in Ohio, I could just shop around for a therapist willing to check a box saying my transition is complete (surgery is not actually a specific requirement).




People are crazy, but who cares. I saw a therapist because I wanted to. I got an HRT letter from her because I wanted one. My doctor never asked and it turns out he doesn't even require them. He specializes in Trans people and his opinion is the majority of people he sees about trans issues are indeed trans. The few that are not still deserve decent medical care and he doesn't want to leave them to self medicate. People are crazy right?

I didn't need a letter for my Orchi and I didn't need a letter for my BA. I knew what I wanted and I'm extremely happy with the result. It's my body, and my business. Anybody that tries to keep me from doing anything with my body is gonna have a fight on their hands. I'm the type of person that will get boobs even if I don't want them just to prove that you're not the boss of me. ;-)

That's exactly how I feel.

People seem to be worried about doctors getting sued. But how does WPATH prevent that? If someone regretted their transition, they could still try to sue just as easily! But since they needed a letter from their therapist, they'd sue the therapist instead of the surgeon.

It seems really bad to put the burden of whether or not someone is trans on their therapist. Or on their surgeon. Or on anyone but the person themselves. Yes, they could be wrong -- although there is shockingly little actual evidence of anyone ever really being wrong -- but who should be blamed if they are?

Your therapist should give you the best care they can. They shouldn't have it hanging over their head that maybe you're so crazy you're faking being transsexual. That basically never happens, but your shrink shouldn't have to worry about being liable for it.




Once in while, I do meet people who wish they were transsexual and would regret surgeries and other body transformations. If one sees transsexuality on equal footing as piercings and other body modifications, then maybe there should be unethical doctors to do the deed for money.

But do you find that the current system helps these people re-evaluate things? Is it working?

I've probably met a little over 200 trans people. And there's so much variety. A lot of them are awkward and lacking social skills, but there are very few that have given me any reason to question their ability to make their own decisions for how to live their lives.

I've definitely met people who I really questioned their mental health. I know a girl who was severely abused at a young age. He was married and had a son. He was a truck driver and a country singer in local bars. Then one day he decided to abandon his son and leave the state and live as a woman. She got on HRT quite easily and got her name changed quite easily and recently got an orchie quite easily. And some days she'll say "I'm all man!" and demand to be called Steve -- which is odd, since her male name wasn't Steve. This girl likes to run off and travel the country being a prostitute. She is a sociopath who steals from people and uses anyone who cares for her. She has been in mental hospitals multiple times. But I don't know if any of us can say whether or not she's really trans. She's just crazy, but is she a crazy woman or a crazy man?

Regardless, it's irrelevant, because when she wants to act femme, she's very convincing, and it was obviously easy for her to convince therapists and doctors.

I met another middle-aged trans woman who went to a group therapy thing with me and went to one of the support groups I went to. She had a lot of manly tattoos she wasn't interested in covering up. She really didn't seem feminine at all. She liked to derail conversations in support groups and talk about cars and motorcycles and guns. When she did talk about being trans, it was with a childish bewilderment. She actually said, "I'm surprised that most of you knew at a very young age that you were trans. I had no trans feelings at all until this year." She showed up at these meetings out of nowhere and very quickly decided she wanted to transition. I was pretty shocked that within two months she was on HRT and had scheduled an orchie.

The truth is that it's unfair of me to say that she realized it too late in life, or that she was just too ugly of a trans-lesbian to be taken seriously.

But my point is that these are the only people who have really given me any reason to question them, and it was very easy for them to get surgery and hormones. Oddly, they were both much more motivated to get surgery and HRT than most of the trans people I know. They're both pretty weird, and it seems like latching on to the trans community gave them friends and a social life that they certainly weren't capable of getting through "normal" means. They managed to get the trans stamp of approval, and I don't see what further restrictions would've prevented that. If their doctors told them they had to wear a dress for a year before they could get surgery they would've done it in a heartbeat, because they're crazy and they don't even put any thought into things. They just have empty lives and want to be driving in a direction and have some purpose.

Does making heroin illegal keep people from doing it, or does it just spread HIV by making it harder for people to get clean needles? In reality, the crazy people who shouldn't be getting SRS are probably the first ones we should give it to, because they're the ones that are going to cut their penis off in the garage by themselves or go to silicone pumping parties if they don't have access.

I just think we need to look at the guidelines and ask ourselves if they do any good or if we're just trying to make ourselves feel better. Because other than strongly encouraging people to get therapy, I don't think it matters.




Perhaps because some people are plain crazy, and would change their mind after taking some medication for a while. They should not be sold machine guns or dynamite either. That is how I think of it, though Pamela seems to express it the other way around.

That's a valid concern, but I think it's pointless to worry about because:

1) There are incredibly few actual cases of these "what if?" cases actually happening where the wrong people get surgery or HRT.
2) These people are going to be able to do what they want anyway, whether it's shopping around for therapists and doctors or just ordering pills from India.
3) Even if trans healthcare were totally locked down, crazy people will do crazy self-destructive things no matter what.

In the end, we have to look more at reality than "what if?" situations. Does gun control work? It's a hard thing to agree on, because on one hand, nobody has a legitimate need to have a damn machine gun, but on the other hand, if guns didn't exist wouldn't a crazy person just throw a few pipe bombs into a crowded theater and maim everybody instead of just shooting the place up? People who are really motivated will take down the WTC with airplanes, or blow up Oklahoma City with a truck full of fertilizer, so it all becomes kinda moot.

But somehow it's supposed to make people feel safer that we're all inconvenienced and I can't take more than 3.4oz of shampoo on an airplane.

When you really think about it, aren't the WPATH guidelines just as pointless? Does it really help anybody to have restrictions on who can do what to their body, or is this just a placebo? And if so, is it working? If it brings legitimacy to our cause -- like actually convincing the general public that we've got a medical condition and we're not just crazy -- then I think it is worth it. But let's be honest about what it really is.

[Badtranny]

I guess if your insurance is going to cover surgery because you're trans -- which would be awesome -- I can understand them wanting a letter from your therapist. Otherwise it might be kinda easy for non-trans people to play them and get free nose jobs, then they'd end up canceling all cosmetic coverage..

OMG, that was brilliant. I want to copy the whole thing but that would just be silly.


While I was reading your awesome dissertation, a question came to me; Are the gatekeepers trying to manage crazy people, or trying to keep the crazy people out?

[Bree-asaurus]

Are the gatekeepers trying to manage crazy people, or trying to keep the crazy people out?

In my experience, the gatekeepers are trying to make sure that I know what I'm getting into... that I'm not crazy... that I'm sane and well prepared for what I'm about to do.

I don't see them as making sure I'm crazy enough to go forward... but I also don't have any bias or chip on my shoulder with therapists, doctors and surgeons that would paint an evil picture of them in my mind.

[Cindi Johnson]

Beth-Lock wrote: "Perhaps because some people are plain crazy, and would change their mind after taking some medication for a while. They should not be sold machine guns or dynamite either."


Obviously, machine guns and dynamite pose threats to others, not to the person possessing them. As far as I know, breasts, whether on GG's or TG's, do not threaten society, unless perhaps they are filled with C-4. Is this really an argument for requiring TGs to hire therapists?

I have no problem with therapy if one chooses it voluntarily. Forcing a girl into therapy just so that she can get HRT or BA or SRS is just plain wrong. But even worse is that we, our community, demand it. We have bought into the lie that TG's are inherently mentally unstable. We must all be crazy!

Well, I've been TG for 60 years now. If I'm crazy, so be it. I have no major regrets about being TG. I have no big "issues" with what I am. Would I like to sit with a therapist each week and discuss things? Maybe. But not at $100 an hour out of my pocket.

BTW, several respondents have discussed therapy in light of insurance or gov't payments for hormones or procedures. Great: if they pay, yes, they have the right to verify the necessity of a procedure. But c'mon! At least here in the USA, your chance of getting paid for hormones or SRS is nearly nil.

[Raquel June]

OMG, that was brilliant. I want to copy the whole thing but that would just be silly.


While I was reading your awesome dissertation, a question came to me; Are the gatekeepers trying to manage crazy people, or trying to keep the crazy people out?

Thanks :)

Manage crazy people? You mean like a methadone clinic? Give them an estrogen patch so they don't go stick a dirty needle in their butt? :)

It seems like they're just trying to keep them out, which doesn't really work, and also doesn't help you manage them. If someone comes to therapy just to get HRT, and you tell them you're not going to give it to them, it's not very likely you'll get them to keep coming to therapy just because they need it.

I guess I don't have any good ideas for managing people or keeping them out.


I don't see them as making sure I'm crazy enough to go forward... but I also don't have any bias or chip on my shoulder with therapists, doctors and surgeons that would paint an evil picture of them in my mind.

I don't get the vibe that anybody is really anti-therapy.

Therapy helps tons of people. Just like rehab helps tons of people, and AA helps people. But I know people who have been court-ordered to go to rehab, and it never really worked. These are the people who show up on your doorstep the day they get out of rehab asking if you wanna get high.

People I know who have pushed their spouse into couples' counseling against their will always still got divorced. And I don't see how forcing trans people to see a therapist is any different.

[Badtranny]

Hmmmm, maybe my question needs to sink in a bit.

Consider this; The WPATH requires a professional diagnoses before HRT and again before SRS. We are essentially required to be diagnosed with a mental disorder before they will let us into their process. It's not really much different than mice being put into a maze to see if they can find the cheese.

Isn't it just a matter of being the "right" kind of crazy in their eyes?

[Bree-asaurus]

I don't get the vibe that anybody is really anti-therapy.

Not in this thread. Some people have expressed elsewhere that they think therapy is bull. I just mentioned it because some people are saying that the therapy is to make sure someone is 'crazy' enough to transition or get surgery because they are trans. I think that opinion is a little biased against the point of seeing a therapist in these situations.


Therapy helps tons of people. Just like rehab helps tons of people, and AA helps people. But I know people who have been court-ordered to go to rehab, and it never really worked. These are the people who show up on your doorstep the day they get out of rehab asking if you wanna get high.

People I know who have pushed their spouse into couples' counseling against their will always still got divorced. And I don't see how forcing trans people to see a therapist is any different.

Well... therapy is supposed to help you help yourself. It's still up to the patient to fix things, not expecting therapy to offer silly promises it can't keep. Couples counseling (IMO) isn't to make sure you don't get divorced, but to figure out what both people need to do to be happy. Sometimes that isn't staying together.

Rehab and AA and such... I won't even touch enter that conversation. Never had to be there myself and knowing how AA works, I KNOW that route would never work for me if I was in that situation.


Hmmmm, maybe my question needs to sink in a bit.

Consider this; The WPATH requires a professional diagnoses before HRT and again before SRS. We are essentially required to be diagnosed with a mental disorder before they will let us into their process. It's not really much different than mice being put into a maze to see if they can find the cheese.

Isn't it just a matter of being the "right" kind of crazy in their eyes?

Well... they wouldn't schedule you for surgery to remove a tumor without testing to see if it was there first. Unfortunately blood-work and an MRI can't diagnose transsexuality (yet).

[Raquel June]

Hmmmm, maybe my question needs to sink in a bit.

Consider this; The WPATH requires a professional diagnoses before HRT and again before SRS. We are essentially required to be diagnosed with a mental disorder before they will let us into their process. It's not really much different than mice being put into a maze to see if they can find the cheese.

Isn't it just a matter of being the "right" kind of crazy in their eyes?

That sounds right, even if the semantics of putting it that way might rub people the wrong way.

The whole WPATH thing just seems well-intentioned but somewhat irrelevant on a good day (since they're just guidelines), or a horrible thing on a bad day -- since caregivers will defer to the guidelines as hard rules in lieu of actually educating themselves on transgender concerns.




Well... they wouldn't schedule you for surgery to remove a tumor without testing to see if it was there first. Unfortunately blood-work and an MRI can't diagnose transsexuality (yet).

It's not like people are lining up to have exploratory holes drilled in their heads because they think they might have a tumor.

But consider these nutty people:

http://en.wikipedia.org/wiki/Body_integrity_identity_disorder

There's just no way I can think someone who wants their arm amputated is anything but insane. But if they're an adult and they're not legitimately mentally disabled they should be allowed to get it done. And I really think this has to be extended all the way to suicide. The most horrifying thing I can think of is to have some kind of painful miserable existence hooked up to a bunch of machines in a hospital and not be able to die. Our right to our own body should be unconditional.

I'm not sure if an actual physical test for transsexuality would be good or bad. It would be a good thing as far as giving us legitimacy in the public eye, but it would be a horrible thing as far as our freedom to not have our lives dictated to us.

I mean, imagine if there was a gay gene. And you could take a test for the gay gene, and then you could have a gay wedding. But then it would be illegal for you to have a heterosexual wedding.

But then there is also the fact that a higher percentage of LGBT people have been sexually abused than straight people. So maybe trauma can rewire your brain a bit. If someone was gay and didn't have the gay gene, would they just have to get therapy and be "cured" of their gayness?

Maybe if there was a trans gene then we all would've gotten on HRT before puberty and everything would be great. But maybe I would fail the trans test and have to shoot myself in the face.

[Bree-asaurus]

It's not like people are lining up to have exploratory holes drilled in their heads because they think they might have a tumor.

LOL! I didn't know people were lining up to get their junk chopped off either! :P


But consider these nutty people

[...]

Maybe if there was a trans gene then we all would've gotten on HRT before puberty and everything would be great. But maybe I would fail the trans test and have to shoot myself in the face.

And that's why I say, if you can pay, do what you want!

As for me, if there was a trans test, I don't think I would even take it. I know who I am and I'm happier now than ever. If I took a trans test and it told me I wasn't trans, that would SO F me up! What if it isn't a 'be all, end all' test? What if there are other causes? I would go insane! What matters to me is that I'm able to survive.

[nikkijo]

LOL! I didn't know people were lining up to get their junk chopped off either! :P



And that's why I say, if you can pay, do what you want!

As for me, if there was a trans test, I don't think I would even take it. I know who I am and I'm happier now than ever. If I took a trans test and it told me I wasn't trans, that would SO F me up! What if it isn't a 'be all, end all' test? What if there are other causes? I would go insane! What matters to me is that I'm able to survive.

bingo.... like i was telling people earlier... the physical is so ouweighed by the changes mentally that the physical changes are only a bonus that adds to conversation sure id like to have instant gratification of a BA, FFS or SRS but if my mind wasnt right that disconnect would still be there...

[Stephanie-L]

One thing that has not been mentioned, or at least only briefly, is that those standards are there not only to protect you, the patient, but also to protect the medical provider. I am not saying any of us is going to come back five or ten years after SRS and sue the surgeon, but we have heard of cases where people have excessive amounts of plastic surgery, and then sue the surgeon when they regret it. Not because the surgery didn't turn out well, but because they were not stable enough mentally to understand the consequences of the surgery. Most experienced plastic surgeons are able to spot people like this, and recommend a waiting period or counselling before going ahead. Of course what happens is that the person doctor shops until they find someone who will do it, usually for a higher price. So, if someone does have issues after SRS, the surgeon can say, "See, I followed the guidelines set up by WPATH, and she passed all of them". This won't help the person having issues, but it will help the surgeon when it comes to lawsuit time.....................Stephanie

[Badtranny]

even if the semantics of putting it that way might rub people the wrong way..


Nah, what are the chances of THAT happening? ;-)

Come to think of it, I don't think anybody has jumped up my ass in quite awhile. What's up with that?

[Raquel June]

So, if someone does have issues after SRS, the surgeon can say, "See, I followed the guidelines set up by WPATH, and she passed all of them". This won't help the person having issues, but it will help the surgeon when it comes to lawsuit time.....................Stephanie

And then the person would just go sue the therapist who wrote the letter telling them they were a candidate for surgery. So the burden is on the therapist to be infallible instead of putting the burden on the patient to take responsibility for getting what they ask for.

[Melody Moore]

And then the person would just go sue the therapist who wrote the letter telling them they were a candidate for surgery. So the burden is on the therapist to be infallible instead of putting the burden on the patient to take responsibility for getting what they ask for.
This is where you are wrong, if the therapist has followed the SoC then there is very little the person will be able to do.

Fact is if you want to undergo any gender/sex reassignment procedure the practitioners and service providers are going
to adhere to the SoC as their Bible even though it is only considered a Guideline because that is the only credible document
they can use to back them up in court. I know you don't like it Raquel, but tough, that is the way the cookie crumbles.
And the reason why I know this is because I founded Trans Health Australia, a group that is now working very closely
with a number of doctors, psychologists etc to find better ways to deliver the services we need. And through this I also
found out that even though the SoC are just guidelines just like the DSM is an US document with no legal bearing through
legislation here in Australia, and yet it is what medical professionals here will follow. Go figure?

[CharleneT]

Some of the steps of the SOC do offer the next step providers with security, and that is why most require the letters. By going thru the process you are doing several things, but one is giving the next step provider legal coverage in case something does go wrong. It is not much different than the forms you sign before procedures saying you understand the risks and won't sue if something goes wrong. When my primary care doc agreed to put me on HRT, he required the letter from my therapist attesting to the fact that I have GID. He knew that dx in spades, I was under his treatment longer than I had been with the therapist (for gender issues). He needed the letter for the file - it is the shield he would potentially need later to protect himself against legal action(s).

A LOT of the steps used in medical care in the US are done as legal cover for the docs !! Why do you think the rate of C-Sections of normal pregnancies is so high here ? Most of the CS babes could have been delivered vaginally, but the docs do not want to take the chance.

The therapist has an "out" too - they can just say you lied and fooled them. Never fear, all medical providers practice "safe medicine" these days. No one in their right mind would practice medicine without a "legal condom" on :doh:

[Jorja]

Never fear, all medical providers practice "safe medicine" these days. No one in their right mind would practice medicine without a "legal condom" on :doh:

Thank goodness because I would hate to get barebacked and catch something. :)

[Cindi Johnson]

Usually I try not to get involved in threads on this site. And yes, I'm trying even now, but I can't help myself.

Please! Of course doctors try their best to protect themselves legally. Any of us who've had even a nose job have had to sign multiple forms affirming awareness of potential side effects, including death. These forms serve only one real purpose: to protect the doctor. But so what? That is not the issue here. All physicians deal with this, yet as far as I know, none require patients to get a letter from a health care professional "verifying" their sanity. Except those doctors who deal with us.

Yet hardly any of us take offense with the fact that the medical establishment presumes we are all mentally unstable. (Which kinda makes me think that maybe the doctors are on to something.) No other group in society would so readily submit to what amounts to forced therapy. The gays fought back and now being gay is not considered a mental illness. But TG's, well, we love our therapy, don't we?

[Raquel June]

This is where you are wrong, if the therapist has followed the SoC then there is very little the person will be able to do.

First you claimed that doctors could easily be sued for giving a genetic male a boob job -- even though you can't find a single instance of it ever happening. Now you're claiming that it would be impossible for someone to sue their therapist?

Maybe you're right. Even though there is plenty of evidence of therapists getting sued, it's not as prevalent as surgeons getting sued.

But you're basically arguing that the system is awesome the way it is and that we need roadblocks otherwise there would be an influx of crazy people wanting gender reassignment, and I find that quite asinine. But again, I understand that you are in the majority here.

It's just pretty frustrating for me to hear. Do gay people need a letter saying they're really gay before they can start a gay relationship? No. And it's not because gay people are the pinnacle of mental health. Gay people often have trouble accepting their sexuality, just like trans people often have trouble accepting their gender identity. But once they figure it out, nobody questions whether or not you're gay. It's up to the person.

And whether or not you're trans is the same damn thing. I am the only one who can decide if I'm trans or not. If I say I'm trans, that should be good enough. I'm as disgusted by the concept of needing a stamp of approval as I would be if I needed a therapist's permission to be homosexual. It's ignorant. And the fact that our community accepts these standards means that our community is accepting the idea that gender dysphoria should be viewed first and foremost as a sign of mental illness.




Fact is if you want to undergo any gender/sex reassignment procedure the practitioners and service providers are going
to adhere to the SoC as their Bible ...

Are you backpedaling and only talking about GRS, or are you actually pretending you can't get a boob job without a letter from a therapist? Because as several people have pointed out here, you don't have to look too hard to find someone to give you a boob job. And doctors aren't getting sued for not demanding letters from therapists. And of course you can just Google for an interview with Brian Zembic.




... But so what? That is not the issue here. All physicians deal with this, yet as far as I know, none require patients to get a letter from a health care professional "verifying" their sanity. Except those doctors who deal with us.

Yet hardly any of us take offense with the fact that the medical establishment presumes we are all mentally unstable. (Which kinda fact makes me think that maybe the doctors are on to something.) No other group in society would so readily submit to what amounts to forced therapy. The gays fought back and now being gay is not considered a mental illness. But TG's, well, we love our therapy, don't we?


Yeah! That's all I was trying to say. So I guess there are other people who are offended.

But in truth, I'm not THAT offended. I'm certainly not surprised. The part that surprises/offends me is that our community is OK with it.

[Jorja]

The part that surprises/offends me is that our community is OK with it.

I don't think anyone in the community is OK with it. That is the way it is for now so you have to deal with it. Change will come one day but change doesn't happen overnight For that change to happen you have to initiate change.

[Bree-asaurus]

Usually I try not to get involved in threads on this site. And yes, I'm trying even now, but I can't help myself.

Please! Of course doctors try their best to protect themselves legally. Any of us who've had even a nose job have had to sign multiple forms affirming awareness of potential side effects, including death. These forms serve only one real purpose: to protect the doctor. But so what? That is not the issue here. All physicians deal with this, yet as far as I know, none require patients to get a letter from a health care professional "verifying" their sanity. Except those doctors who deal with us.

Yet hardly any of us take offense with the fact that the medical establishment presumes we are all mentally unstable. (Which kinda fact makes me think that maybe the doctors are on to something.) No other group in society would so readily submit to what amounts to forced therapy. The gays fought back and now being gay is not considered a mental illness. But TG's, well, we love our therapy, don't we?

Instability isn't the right word to use. We need to prove, in fact, that we are quite stable before getting those letters of recommendation for HRT and SRS.

And you are contradicting yourself... are transsexuals proving their sanity or being diagnosed with a mental illness?


I don't think anyone in the community is OK with it. That is the way it is for now so you have to deal with it. Change will come one day but change doesn't happen overnight For that change to happen you have to initiate change.

This.

[Frances]

And whether or not you're trans is the same damn thing. I am the only one who can decide if I'm trans or not. If I say I'm trans, that should be good enough. I'm as disgusted by the concept of needing a stamp of approval as I would be if I needed a therapist's permission to be homosexual. It's ignorant. And the fact that our community accepts these standards means that our community is accepting the idea that gender dysphoria should be viewed first and foremost as a sign of mental illness.


Are you backpedaling and only talking about GRS, or are you actually pretending you can't get a boob job without a letter from a therapist? Because as several people have pointed out here, you don't have to look too hard to find someone to give you a boob job. And doctors aren't getting sued for not demanding letters from therapists. And of course you can just Google for an interview with Brian Zembic.

From reading some of the posts in this thread, one thing is clear to me. Americans have a very different conception of medical care than non-Americans. In social-democracies with socialized medical care, it is not so much about the individual needs and wants. We all share the costs of everyone's ailments equally. If I think my transsexuality is worthy of medical care and surgical intervention, I don't feel it's enough for me to just claim that I am trans. I find it sensible to have to undergo some kind of test, and therapy for mandated period of time is the best way to do it.

The States have a unique society in regards to medecine, gun ownership and individuality as a whole. Though I live only 30 minutes from the border, the U.S. sometimes seem to be a whole other planet.

[Kate T]

Why all the doctor bashing here?

A medical degree in Aus is 7 years. My understanding is that in the US it is at least as long if not longer. They then will typically do a 1 year internship and at least a 2 year, often 3-4 year residency. Thats at least 10 years of training (and believe you me, that training is HARD) before they can set up practice. And that is not even becoming a specialist.
Yes some doctors are arrogant. Yes some (very few) are interested in money. But a MAJORITY are concerned about their patients welfare.
Yes, you are the only person that really "knows" if your are trans. Your medical practitioner though knows the pro's and cons, complications, expected, likely and unlikely outcomes of any procedure that you may wish them to perform. For the most part they are trying to help in the best way they can.

[Raquel June]

If I think my transsexuality is worthy of medical care and surgical intervention, I don't feel it's enough for me to just claim that I am trans. I find it sensible to have to undergo some kind of test, and therapy for mandated period of time is the best way to do it.

The surgery is free for those who qualify, so you need to make some arbitrary distinction of who qualifies and who doesn't? Is this really a problem? Why? Because crazy people will pretend they're trans, and you think you're more deserving than they are?

I guess in the end these are all hypothetical concerns, because there aren't that many people getting denied SRS. I don't know of many people getting denied SRS, and I don't know of many people getting approved for SRS and then regretting it. Although I did hear of a girl getting denied SRS because her hands were too big and she would never pass anyway so why get SRS? But she was able to find a different doctor.

But the part where you have to "undergo a test" just sounds like you're endorsing the government judging people based on "how trans" they are, and that kind of thinking just results in trans people who are less passable and/or more socially awkward having an even worse life. And trans people who are a little weird and/or don't have passing privilege have a tough enough time.

The healthcare thing is such a touchy subject. I spent many years worried about getting sick because I would had no insurance and I'd just have to go to the ER and wait around all night to get seen. But I can also appreciate that people need food more than healthcare. And nobody is saying that the government should nationalize grocery stores and make all the food free. The real tragedy in the US is the price of health care, not access to it.

I guess I shouldn't go too OT, but my grandparents live in Florida and they have several Canadian friends who spend half the year in Florida, and they all go to the doctor in the US even though it's free in Canada because they get better care in the US. I also knew several nurses in Phoenix, and they often commented about the "snowbirds" all wanting doctors visits before they went back to Canada for the summer so they could avoid dealing with the health care system there. So the US must be doing something right. But they're doing plenty wrong, too.




Yes, you are the only person that really "knows" if your are trans. Your medical practitioner though knows the pro's and cons, complications, expected, likely and unlikely outcomes of any procedure that you may wish them to perform. For the most part they are trying to help in the best way they can.

So we should all have access to education about the pros and cons, complications, etc. But how much of the SOC is really about patient education?

[Frances]

The surgery is free for those who qualify, so you need to make some arbitrary distinction of who qualifies and who doesn't? Is this really a problem? Why? Because crazy people will pretend they're trans, and you think you're more deserving than they are?

I guess in the end these are all hypothetical concerns, because there aren't that many people getting denied SRS. I don't know of many people getting denied SRS, and I don't know of many people getting approved for SRS and then regretting it. Although I did hear of a girl getting denied SRS because her hands were too big and she would never pass anyway so why get SRS? But she was able to find a different doctor.

But the part where you have to "undergo a test" just sounds like you're endorsing the government judging people based on "how trans" they are, and that kind of thinking just results in trans people who are less passable and/or more socially awkward having an even worse life. And trans people who are a little weird and/or don't have passing privilege have a tough enough time.

You have it backwards. I went to see doctors to figure out how to go on living, not to change sex. I did not think I was more deserving of anything. Like I said, I don't think most Canadians see things this way. I was going to kill myself, not because I wanted to wear pretty dresses and society was not letting me, but because I felt wrong within my own skin and in my place in the universe. The best thing would have been to be "cured" and to remain a guy. Once I accepted I was trans, they put me in this program with a gender committee and lengths of time where I had to be under observationd (for which I had to pay). They never said I was trans, and they never recommended hormones or surgery. They did, however, give me letters for both when I asked.

I saw many people go through the program over the years, and passability or the level of transness was never an issue. The only thing that mattered was understanding the shortcomings of transition and being able to handle issues like "not passing." Even so-called autogynophelia was NOT a reason to reject anyone.

Raquel, you seem to have issues with authority and socialism from what you write. You are making some projections that are just not true.

[Melody Moore]

Are you backpedaling and only talking about GRS, or are you actually pretending you can't get a boob job without a letter from a therapist? Because as several people have pointed out here, you don't have to look too hard to find someone to give you a boob job. And doctors aren't getting sued for not demanding letters from therapists. And of course you can just Google for an interview with Brian Zembic.

Jeez you like to argue with everyone and bash your head against the wall when you have it all wrong Raquel.

Irrespective of what you or I think or believe 99% of doctors are going to look at breast augmentation on a genetic
male as a gender/sex reassignment procedure and therefore they will refer to the appropriate guidelines. There is that
odd 1% of surgeons who will bend the rules because they have no morals and are just very greedy. Brian Zembic did
this purely for a bet and a publicity stunt and he did manage to find such a surgeon who would do the job for cash
because this was for $100,000 bet I do believe yeah? The Brian Zembic case is NOT your typical case and therefore
it does not represent the way policy works for most surgeons. And that is what is most important here for the OP.

The OP has some issues with family members who don't know bout their crossdressing, these are issues this person
has not addressed. A drag queen who decides to get a boob job & is out to everyone does not have these types of
issues either, so it is like comparing a banana to a potato.The bottom-line is doctors and surgeons ar going to follow
guidelines and there is no "mighter-than-thou" attitudes here. These are trans people who know and understand how
the medical systems work. So either you can take on that advice or be ignorant & stay in the dark about how things are.

But I am done arguing with you because you just simply don't get it.

[Kristy_K]

I am not trying to disagree with anyone but I didn't need any letters for a BA or my FFS. I must have went to right Dr.s the first time or maybe it was that I went there in a dress.

[Frances]

I am not trying to disagree with anyone but I didn't need any letters for a BA or my FFS. I must have went to right Dr.s the first time or maybe it was that I went there in a dress.

You are in the U.S. Things work differently in other countries.

[Traci Elizabeth]

Jeez you like to argue with everyone and bash your head against the wall when you have it all wrong Raquel.

Irrespective of what you or I think or believe 99% of doctors are going to look at breast augmentation on a genetic
male as a gender/sex reassignment procedure and therefore they will refer to the appropriate guidelines. There is that
odd 1% of surgeons who will bend the rules because they have no morals and are just very greedy. Brian Zembic did
this purely for a bet and a publicity stunt and he did manage to find such a surgeon who would do the job for cash
because this was for $100,000 bet I do believe yeah? The Brian Zembic case is NOT your typical case and therefore
it does not represent the way policy works for most surgeons. And that is what is most important here for the OP.

The OP has some issues with family members who don't know bout their crossdressing, these are issues this person
has not addressed. A drag queen who decides to get a boob job & is out to everyone does not have these types of
issues either, so it is like comparing a banana to a potato.The bottom-line is doctors and surgeons ar going to follow
guidelines and there is no "mighter-than-thou" attitudes here. These are trans people who know and understand how
the medical systems work. So either you can take on that advice or be ignorant & stay in the dark about how things are.

But I am done arguing with you because you just simply don't get it.



Ahem Sister !

[kellycan27]

I believe that the question posed by the OP was in regards to the legality of a man getting breast implants. Here in the US it is not against the law. Whether a doctor has a moral objection, or the OP has issues is neither here nor there.

Melody I believe that your 99% statistic was pulled right out of your backside and if it wasn't I for one would like to see the proof of your statement.
Cosmetic surgery is big money, and the surgeons will do pretty much what the patient asks for within reason. What's the difference between a man who wants a B/A and a woman who wants 56DDDD boobs?
You go in sign the disclaimers, pay your money and you go out with boobs. Your "family issues" are of no concern to your doctor.. that's your problem. He is after all your doctor.. not your keeper. If as you say doctors are concerned with being sued, then they should require a therapist's letter for anyone who wishes to have a procedure done. They stand a better chance of getting sued by the sheer volume of patients rather than that one or two that wish to get an unconventional surgery.

[Melody Moore]

Melody I believe that your 99% statistic was pulled right out of your backside and if it wasn't I for one would like to see the proof of your statement.
You reckon I pulled that figure out of my backside eh? Maybe I did, but let me put a few things into perspective for you.
Here in Australia there is currently 2 cosmetic surgeons performing sex/gender reassignment procedures and a new surgeon
about to start up here soon. Not one single one of these surgeons will perform an sex/gender reassignment procedure without
having all the appropriate letters of recommendation from a psychologist or psychiatrist. So here in Australia it is a 100%!

Now going by these two past comments by the OP...


the surgeon that i found to do my breast aug said he had to find out the legality of doing my breast aug.

And this post here >>> http://www.crossdressers.com/forums/showthread.php?178561-hormones-therapist


went to my family doctor about hormones, told him about talking to a surgeon about breast implants my GP wants to know if the surgeon thinks I need a therapist, I don't think so, going to have implants, hoping in about 30 days

It seems pretty obvious to me that if you are a genetic male getting breast augmentation in the USA is not as easy
as you think when both a GP and the surgeon himself are asking questions. I don't know what the story is in the UK
and other countries, but I know here in Australia the surgeons love the gatekeepers because they cover their butts
legally, REGARDLESS of whether or not you and I agree with them and this is what I also base my understanding on.

[kellycan27]

Not one single doctor out of two huh? HAHAHAHHAHAHAHAHHAHAHAHHAHAHAHHA! That is hilarious.. You don't know about the third doctor so your statistic is closer to only half..... 66-2/3 percent . LMAO

[kellycan27]

You reckon I pulled that figure out of my backside eh? Maybe I did, but let me put a few things into perspective for you.
Here in Australia there is currently 2 cosmetic surgeons performing sex/gender reassignment procedures and a new surgeon
about to start up here soon. Not one single one of these surgeons will perform an sex/gender reassignment procedure without
having all the appropriate letters of recommendation from a psychologist or psychiatrist. So here in Australia it is a 100%!

According to some plastic surgeons, the males that want to have breast implants for them should make clear their gender issues. Due to the lack of differences in the treatment of the breast implants for men and the breast augmentation for women, some of the plastic surgeons decline to do this surgical procedure on males. Therefore, it is essential for the males to explain their sex in the first appointment with the plastic surgeon. Once the gender of a patient is clear, it is very simple to acquire breast implants for men.

Seems like a simple explanation can get the job done.. I didn't see any mention of the SOC regarding men who wants a B/A.

http://www.doctorbeam.com/male-breast-implants-glastonbury.aspx No mention of the SOC or moral issues here

[Melody Moore]

Not one single doctor out of two huh? HAHAHAHHAHAHAHAHHAHAHAHHAHAHAHHA! That is hilarious.. You don't know about the third doctor so your statistic is closer to only half..... 66-2/3 percent . LMAO

For your information, the new surgeon is an understudy of the other surgeon who is retiring
and he will be working for gatekeepers just like his Mentor. So it's still a 100% result :D

[ReneeT]

wow - what a bitchy thread! maybe everyone should step back and check their estrogen levels........

[Mary Lee]

I am 66 and have man boobs all most a 36A. Does this 69/70 year old have man boobs? How much breast tissue is needed?

[pamela_a]

You reckon I pulled that figure out of my backside eh? Maybe I did, but let me put a few things into perspective for you.
Here in Australia there is currently 2 cosmetic surgeons performing sex/gender reassignment procedures and a new surgeon
about to start up here soon. Not one single one of these surgeons will perform an sex/gender reassignment procedure without
having all the appropriate letters of recommendation from a psychologist or psychiatrist. So here in Australia it is a 100%!

Now going by these two past comments by the OP...



And this post here >>> http://www.crossdressers.com/forums/showthread.php?178561-hormones-therapist



It seems pretty obvious to me that if you are a genetic male getting breast augmentation in the USA is not as easy
as you think when both a GP and the surgeon himself are asking questions. I don't know what the story is in the UK
and other countries, but I know here in Australia the surgeons love the gatekeepers because they cover their butts
legally, REGARDLESS of whether or not you and I agree with them and this is what I also base my understanding on.

Did I miss something here? The OP was asking about BA. NOT SRS. SOC 7 recommends 1 letter for BA but that doesn't mean it's required by anyone.
I know there are some out there who believe the SOC was written with Divine guidance but there are plenty of surgeons who will accept informed consent for a BA instead of requiring the ingestion of the proper amount of SOC Kool Aid.

[Serana]

Here in the UK, it's a little more 'organized' in the sense of you needing letters of support or recommendation from the GIC that you're seeing, or from the private doctor you're seeing that has diagnosed you with gender dysphoria or whatever they choose to call it.

In the sense of the legality of things, I'm assuming a doctor who is responsible would want to see if there's maybe a way to take each individual patients needs into account. Because of the guidelines set out in Harry Benjamin Standards of Care (http://www.tc.umn.edu/~colem001/hbigda/hstndrd.htm for those who read, do a ctrl+f on 'breast' and you'll find section "XII. Requirements for Genital Reconstructive and Breast Surgery"),it makes it harder to just 'go and get a boob job' without there being legality behind it. You'll notice also there in those brackets that GRS and BA are mentioned in the SAME SECTION.

The reason for this is the fact that it's a -major- surgery. Think about it, if every person who got the small feeling of wanting breasts, how many people do you think would be getting it done? There are some pretty 'kinky' men out there after all. And yes, I appreciate that sometimes these 'guidelines' are stretched by doctor's, and that is where we see the 'case by case' basis of things being taken into account by doctors and them being responsible for their patients. Also try and see it in a more realistic view; every country may have slightly different standards of care, or slightly different rules applied to GICs and GPs, Surgeons, etc. etc. and I very much doubt all that many of them are completely aware of it.

Also, legality wise, we can be whatever the hell we want to be, I could be a polka-dot chicken with a waistcoat if I wanted, but if I went around telling everyone I was a polka-dot chicken with a waistcoat, they'd be a bit perplexed. Why? Because I'm not a polka-dot chicken with a waistcoat. In a realistic sense, I can say I'm a transsexual, and I can say I'm a woman, but (and please, no rage at this it's still a fact of life), nobody else sees that straight away. On HRT and such, then yes, it's a bit easier to say such. However, if you've never taken hormones, never seen a GIC, or seen anyone about the issue before, then obviously questions -WILL- be asked. They will want you to see a therapist/psychiatrist/GIC etc. etc. to get some form of referral in which to cover their own ass. And why not? They should be more than free to do so.

It's about proving you are what you say you are because they don't exactly follow us around all the time ticking boxes. These are all considered case by case. You can go to a doctor and say you want BA, but without letters of referral or anything, it's you against many.

Case in point, there are rules, there are laws, and as sad as it may be for everyone, we -have- to follow

I'm quite surprised actually that this became quite a heated debate, all things considered.
Either way, hope this maybe helps quell some minds instead of bringing more anger with increased fervor.

Seri-chan~

Also, just read this on the SOC that says "Can Hormones Be Given For Those Who Do Not Initially Want Surgery or a Real Life Experience? Yes, but after diagnosis and psychotherapy with a qualified mental health professional following minimal standards listed above. These cases often are deeply controversial and require particular caution. " It's not a straight relation to BA, but I'm pretty sure it would be maybe more controversial, and perhaps harder to get. Just food for thought. Think the keyword here is controversial perhaps, and many here seems to forget how controversial being transgender is still.

Just something to keep in mind. Much love~ :)

[Aprilrain]

There is no debate, the OP is in the US and is asking about US law regarding BA, there are no such laws. The DR is within his or her rights to ask for whatever letters he or she wants, however there are NO LAWS!!!!!
Even if there were laws the laws would be for a particular state and not for the entire US.

[Serana]

Perhaps I was little loose with the term laws, I think a better word to use would have been procedures. If they're in the US I doubt I would have much else to offer being based in the UK, but a bit of research and learning is always good for the soul. I always personally thought in some ways that the SOC was used as 'laws' or a code of ethics to be followed with procedures personally.

I suppose in terms of actual legality then, it would have to be at the discretion of the DR? Or are there medical laws surrounding it perchance?

Thanks for picking up on the word use btw, cheers~ :)

Seri-chan~

[Melody Moore]

Nothing is legislated in law in most states in Australia, however South Australia is the only state that has Sex/gender reassignment
covered under any sort of legislation. And the man responsible for this is a well known psychiatrist and gatekeeper, Dr Rob Lyons.
He has also tried to start his own body here called ANZPATH and the the policies are ultra conservative and only serve to benefit
the gatekeepers who are monopolising from the trans community in South Australia. Many trans people move interstate to get away
from this. However they still come up against other gatekeepers who adhere strictly to the guidelines because of the litigation risk,
even though there is no laws that exists within the legislation in the other states. So go figure?

And for those that don't get it, many doctors and surgeons will consider Breast Augmentation a "sex/gender reassignment procedure"
and therefore will treat the matter as such. And while there are no laws in place this will not stop medical practitioners asking for the
letters they want like April says. I have said it a number of times already that the SoC are only guidelines, but it is a document that
has been used in determining court decisions already. And while you might get the odd foolish surgeon who will stick his neck out and
take a risk with performing BA surgery on a non-transsexual/transgendered male without letters of recommendation, I think you will find
that the greater majority of them around the world won't want to go anywhere near it.

[Raquel June]

People are getting really side-tracked arguing about socialized medicine. Is that really the point? If you live somewhere where you pay extra taxes that the government then uses to attend to your needs, then they're going to want proof that you "need" a boob job before they pay for you to get one. If you live in the US and you pay for insurance, your insurance will not pay for a cosmetic surgery unless they accept that you "need" it.

That's the point, right? If somebody is paying for my needs, I may be asked to prove that they are in fact needs.

But if I'm paying for a cosmetic procedure with my own money -- whether it's a nose job or a boob job or a vagina -- it would be ridiculous for me to have to schedule months of therapy and get a letter to prove my sanity.




You have it backwards. I went to see doctors to figure out how to go on living, not to change sex. I did not think I was more deserving of anything. Like I said, I don't think most Canadians see things this way. I was going to kill myself ...

I saw many people go through the program over the years, and passability or the level of transness was never an issue. The only thing that mattered was understanding the shortcomings of transition and being able to handle issues like "not passing." Even so-called autogynophelia was NOT a reason to reject anyone.

I'm pretty much agreeing with everything you said. But I'm agreeing with you because you're going a completely different direction than in your previous post where you said everyone should be "tested."

I don't think you're saying that everybody should be suicidal like you were before they get treatment. And you're implying that the educational part of your program was a good thing. So you are an example of the system working perfectly. But some people do have their minds made up, and they're not suicidal. If you already knew your were trans, and you had already educated yourself about transition, how much time and money would it take for you to prove it to the authorities and get that letter?

Maybe it wouldn't take much time or effort or money. And in the grand scheme of things, I guess it's no big deal compared to all the other stuff we go through and the cost of other aspects of transition.

I guess it is just an entirely different philosophy about our rights to our own bodies. If people recommended a program to you, and offered you education on trans stuff, that's awesome. I just don't like the letter part. And if they give everybody the letter who asks for it (as you seem to be saying they do), then why have it in the first place?




Jeez you like to argue with everyone and bash your head against the wall when you have it all wrong Raquel.

Irrespective of what you or I think or believe 99% of doctors are going to look at breast augmentation on a genetic
male as a gender/sex reassignment procedure and therefore they will refer to the appropriate guidelines.

You're unquestionably wrong, as several people have pointed out.

I'll take your word for it that it's harder to get a boob job in Australia. While it's nice of you to point that out, it's ridiculous that you keep ranting that 99% of doctors will need proof that you're trans.

Who's the one here who likes to argue and beat her head against the wall?

[Frances]

I guess it is just an entirely different philosophy about our rights to our own bodies. If people recommended a program to you, and offered you education on trans stuff, that's awesome. I just don't like the letter part. And if they give everybody the letter who asks for it (as you seem to be saying they do), then why have it in the first place?

The program does not offer education on trans stuff. They represent the government who needs reassurance that this trans stuff is for realz. So they have set periods of time that people have to be observed in group and individual therapy. The hospital where I meant had a two-year minimum. If the patient/client gets to the end of the two years and is deemed sane, then letters are given upon request. So they give the letters in exchange for $7,000 worth of therapy. (I was actually five years in the program, so it cost me over $15,000)

I totally agree that this therapy is overkill for a lot of people. They have relaxed the rules somewhat in the province, and it is now possible to see other psychiatrists and psychologists much shorter periods of time while still making the government happy.

So, I agree completely. If you are paying for everything, you should be able to get what you want from anyone. If someone else is paying, then you have to follow their rules. In Quebec, you cannot get a BA without a letter from a psychologist, but the letter can be obtained after one session.

For the record, I too have a problem with authority, so imagine having to go through five years of individual and group therapy and sitting in front of gender committees (with up to 20 people in them) who hold the power to grant or deny me SRS after $15,000 worth of therapy!