Does RLE Make Sense When ...

[LeaP]

You've had FFS, BA, orchie, and possibly additional plastic procedures performed?

After all, if the point is to avoid irreversible changes, then that purpose is undermined quite a bit by the above!

The thought was triggered by Misty's "point of no return" thread. 'Cause I have to tell you, she is past the point of no return. I understand that some of those procedures are theoretically reversible, at least the implants and soft tissue changes. But the bone work is not & the soft tissue work is by no means certain.

So, in such a circumstance, what is the point of RLE?

[Angela Campbell]

To reduce legal liability most likely.

I have found that in Thailand the law says they have to have 2 letters one from a therapist (MS) and one from a psychologist (PHD) stating you have been on hormones a year and living in your desired gender for a year.

[Inna]

I hope I do understand your question, if I do NOT then please excuse me.

However you do mention all the Surgical intervention and then a RLE (Real Life Experience) which at least by the Harry Benjamin s suggestions was a good way to make sure a Transsexual person would not make the mistake of exactly what you point out and end up transitioned yet stuck in the new avatar without prior weeding out of Fetishism.

So in other words RLE comes way before any script for surgical intervention!!!

Personally as well as many therapist, do voice a discontent over the practice of RLE, because of its barbaric connotations. I feel as though a person who is already acutely dysphoric now is asked to make a display of them selves in front of everyone they can come across and inevitably get more heat and discomfort while doing so. Instead I am for the SMOOTH approach, and gradual immersion of gender fixed mind into the ever changing and transforming body.

[Angela Campbell]

It is better than it could be. Some still want you to do a year of rle before hormones.

I personally plan to have some ffs and BA next spring which is before a year is complete.

[Kathryn Martin]

The requirement is to have RLE of at least one year before you have major surgical intervention of any kind. The issue is whether you can successfully interact in a social and professional environment which is the reason why RLE conditions either have you working or volunteering heavily. The point is to experience the push back and to make sure that you can both navigate the push back and assert yourself appropriately in these environments without running for cover when the going gets tough.

When you can meet these conditions and have no mental health issues you can have the bridge burning procedures.

[PaulaAnn]

I can only speak of my own slant on this.....All I know is this ,I WAS going to live the rest of my life as Paula weather or not I had the SRS and/or HRT. I'd reached the point where I was going to live the "RLE" regardless.Luckily I was able to contact a caring Doctor and had wonderful friends who guided and supported me when I started HRT. I've lived as Paula and been on HRT for nearly a year now.....awesome experience ;never been happier.
I'm on the long waiting list for SRS,have my first visit with the Psychologist in five days....My previous doctor(in Sask.) and my current doctor will submit the necessary letters when needed.
Bottom line....if I had none of the medical and mental support(Medical) I mention ,I STILL would have made the the decision to go the RLE route.I still would have the support of my friends but it would have been a much bumpier journey.
Again ,just my own vision;I'm doin' fine.
PaulaAnn

[Beth-Lock]

Much the same with me Paula Ann. I got frustrated with the muddle in professional advice, roadblocking, etc., and actually started my RLE, (that is 24/7), all by myself. I soon got into emotional problems and then found a new counsellor, a specialist in transition, and was back on the official track as she cleared up the emotional crisis as well. Two years later I had a small party in a nice restaurant to celebrate that seeming milestone with champagne, but it was more than a year later before I got SRS.


...RLE comes way before any script for surgical intervention!!! Personally as well as many therapist, do voice a discontent over the practice of RLE, because of its barbaric connotations. I feel as though a person who is already acutely dysphoric now is asked to make a display of them selves in front of everyone they can come across and inevitably get more heat and discomfort while doing so.

While CAMH in Toronto was still insisting on RLE before HRT, Ottawa therapists had stopped insisting on the RLE, since the facial feminization of HRT was in itself, something that made TS easier to pass, or so the TS themselves thought. At least the physical effects of 6 months or so of HRT is reversible normally, so it is a logical point to compromise on. Oblivious to all this, I decided when I took on transition by myself, to go for the full two year RLE, (the gold standard anyway), though it was considered here, obsolete. Add several more years,before RLE started, experimenting on how to pass in public, CD'ing mtf, by adjusting mannerisms and getting make-up and style right, and I was just about as well prepared to pass as much as physically possible for me, without HRT or FFS,by SRS time, and was getting comfortable being dressed as a woman in public. And you don't need a letter from a doctor to prepare that way, and see if you are going to be comfortable with presenting as a woman and assuming the role at least enough to pass. It is also relatively inexpensive.

Footnote: CAMH is the centre for TS counselling and approval for OHIP medicare funding of SRS. CAMH=Centre for Addiction and Mental Health, (treatment of, that is).

[I Am Paula]

After getting my HRT readiness letter, I asked my therapist about RLE. She just said that I had been full time long enough now, and my RLE was over. I didn't even know it had begun, I was just being me!

[KellyJameson]

I often wonder how much of an influence being born feminine looking affects the development of a female gender identity forming and corresponding gender dysphoria that propels the person into transitioning.

Would GID have become so strong in me if people had not always told me I look " pretty" like a girl when I was a child and teen even though they were being cruel about it at the time.

I have seen many of these same physical traits in other transsexuals including many on this forum.

I think RLE is redundant when you not only already appear feminine but through electrolysis, HRT and subsequent breast growth you MUST present as female.

RLE is more important when the difficulties of transitioning are greater because the difficulties of passing are greater.

I watch for stories of those who have detransitioned or committed sucide and I have never seen this happen with someone who passes easily except for one where the church was involved and paid for the reversal.

Those who transition who have masculine features may benefit from RLE so that they are fully aware of how society is going to respond. It may give them the time to develop that thick skin they will need.

For those who were tortured in childhood because they appeared feminine, their transitioning may be easier because they will probably pass where the ones who were able to play the role of the masculine man in appearance and behavior will now possibly have a more difficult path to walk and in this instance RLE could prepare the person for a more difficult passage.

Society can be very cruel to those who do not "measure up"

[Rianna Humble]

I have to wonder what several posters in this thread understand by the term RLE.

As I understand it the Real Life Experience is about living 27/7/365.25 as a woman (for MtF or a man for FtM). As Kathryn says, it is about living and working in your correct gender role.

The point is to experience the push back and to make sure that you can both navigate the push back and assert yourself appropriately in these environments without running for cover when the going gets tough.

In these terms, I don't understand why people think that this experience would be unnecessary simply because you had been teased as a child for having slightly feminine features or even why the OP wonders whether it is necessary to live as a woman after FFS, BA etc.

The only way that these questions would make any sense to me is if RLE is not being used in the WPATH terms so well explained by Kathryn but in the sense of "RLE = gatekeepers trying to prevent me being a woman by insisting that I live as one"

[bas1985]

In the ONIG standards of care (ONIG is the Italian official standard for Transsexuals, which is a bit different from WPATH), the RLE is thought in this way. In Italian there is a proverb which says: "You wanted the bike, now push the pedals!".

(That means that you cannot have a motor, you wanted the bike and a bike won't run if you don't press the pedals ( = effort)).

So RLE means to test that you can FUNCTION as an active member of society, work, play, talk, as a REAL member of the opposite sex.
Not only in TS support groups, but in everyday, cis-people life.

[Angela Campbell]

No one who is on this path wants to be held back by the gatekeepers, that is natural. I do see it as important. Then again the FFS, BA, and orchie can be part of the RLE. In my case I plan to get some facial surgery as I begin my RLE.

[emma5410]

I have found my RLE tough but I am glad I am going through it. I am learning a lot about myself and what it is like to live as a woman 24/7. An earlier thread discussed de-transitioning. Skipping RLE would make that more likely in my opinion. Sometimes we think we know what is best for ourselves and we are wrong.

[Kimberly Kael]

I find the whole premise confusing. As has been pointed out, RLE is generally required before surgery, but more to the point: how are the stipulations of RLE in any way a problem for a transsexual? Isn't that the goal in the first place? To live openly as your identified gender? It shouldn't be a hardship (which isn't to say it's easy!)

[LeaP]

The topic or premise seems confusing to many. Let me try it a different way.

If one of the major points of living in your target gender for at least a year is to head off making an irreversible surgical error (SRS), then what do I make of the common situation of STARTING RLE with FFS and other procedures? How meaningful is it to start the clock for one irreversible procedure when you initiate it with another?

[Badtranny]

Using myself as an example, I started RLE with boobs and FFS. Which is Lea's point. Why should I wait a whole year to get the 'final cut".

It's a good question, but I think changing your primary sexual characteristic is probably worth a year of refection before you do it.

[LeaP]

Maybe, Misty, but mileage varies. I'm in my 50s and we already have six children (all grown). The gatekeeping is starting to look to me like a validation of the (false) notion that FFS is cosmetic - and therefore of little serious medical concern - and an overwrought concern for fertility.

[Kaitlyn Michele]

I did the same as Misty... I started my RLE in july and had ffs in September.. I was 48 at the time

...I viewed ffs as no less conforming than grs

[Angela Campbell]

I find the whole premise confusing. As has been pointed out, RLE is generally required before surgery, but more to the point: how are the stipulations of RLE in any way a problem for a transsexual? Isn't that the goal in the first place? To live openly as your identified gender? It shouldn't be a hardship (which isn't to say it's easy!)

To answer this will not sound rational but it is the way it is. The closer you get the faster you want it to go. The more you want it. To live openly is the end result but you still know you are not right even if no one else does. I clearly understand the purpose and I intend to go through the hoops and wait, but if I could go in tomorrow I would be sitting at the door all night waiting.

[Inna]

I am sorry but this question is irrelevant.

RLE is a "REAL LIFE EXPERIENCE" TEST! It is there to qualify a patient and make sure about their intention and resolve in embracing their perceived self. I stress on "Perceived" because we do not have yet a definite technology to show to the therapist that Transsexual person is really a Transsexual, however we are getting close.

So RLE is simply a testing ground for such person. Living as a woman and actively transitioning while at it, is simply just life going forth. It is either already past the therapy or a decision of an individual to do it anyway, on their own!
But at that point it simply just becomes Real Life transition as suppose to Medical term of RLE.

[emma5410]

The topic or premise seems confusing to many. Let me try it a different way.

If one of the major points of living in your target gender for at least a year is to head off making an irreversible surgical error (SRS), then what do I make of the common situation of STARTING RLE with FFS and other procedures? How meaningful is it to start the clock for one irreversible procedure when you initiate it with another?


The same could be said of HRT. Some aspects of which are irreversible. Maybe HRT and FFS should not be allowed until after RLE. Of course that could make the RLE almost impossible and doomed to failure.
If you use the NHS in the UK then they expect you to live the first 3 months of your RLE without hormones. You could say they are setting you up for failure.
I think the attitude is that SRS is the most drastic of all the procedures. Once your penis has been removed then it is impossible to replace it in its present form.

We all know that some people believe that they are TS only to find being a woman is not what they wanted or expected. If they do the RLE then maybe they would realise that before SRS. Of course, those who are convinced they are TS find that restrictive and want SRS on demand. Everyone is sure that they are in the second group and not the first until the moment they find themselves in the first group and de-transition.

I am not sure that this question has an answer. At the end of the day we are all responsible for our own lives. Or should be, but increasingly we live in a blame culture. If we make a bad decision then it must have been someone else's fault. Maybe that is what makes the medical profession reluctant to sign off too quickly on SRS.

As I said earlier I have found my RLE invaluable. But then, I was already on HRT beforehand so I have already changed my body in some respects. In that sense I am in the camp of not waiting fully for RLE to do its work. But I still feel that SRS is the biggest step of all and should have some gate keeping around it.

[sandra-leigh]

As far as my local trans health clinic was concerned, I had started RLE years before I asked for hormones.

I have never asked, so I am not positive, but the indications I've seen from my trans health people and therapist are that they would clear me for SRS if I asked. But my therapist would first want to know what I was going to do about my relationship. I don't think any of the people involved would be asking for more RLE from me. But to be sure, I have no intention of considering SRS seriously until I have at least done a legal name change (and so essentially "come out" to the rest of my relatives and friends) and lived with that for awhile.

[Kimberly Kael]

To live openly is the end result but you still know you are not right even if no one else does.

No amount of surgery is guaranteed to change your self-image, nor is practical experience a cure-all for that matter. Where it gets sticky is that for some it's next to impossible to be perceived as female without at least some intervention, which muddies the water. Finding a path forward with minimal risk where you can still start to see some success and determine whether it feels comfortable or not should be the real goal. I think that's how many gatekeepers are starting to reinterpret the guidelines.

For me that was possible without surgery or HRT and I found that initial approach very rewarding. I've been able to approach subsequent decisions as any other woman with a hormone imbalance and other genetic challenges. YMMV.

[Badtranny]

On the one hand, I agree with LeaP, on the other hand Sandra-leigh throws a curve ball by believing she is in RLE when she hasn't even changed her name or come out to relatives.

How can one be living full time as a woman and yet not be out is beyond me, but I guess my idea of what a Real Life Experience is may be different than others.

I think living and working full time as your intended gender for a scant 12 months isn't very much to ask of someone before SRS is cleared. My first year flew by before I knew it.

[Angela Campbell]

This is a psychological thing and it is common for some to convince themselves prematurely this is the right thing and the possibility for making poor decisions is a concern. The medical community really does not know enough about this to diagnose so they tend to err on the side of caution. Sometimes too much, sometimes not enough. Of course anyone who desires SRS wants it NOW, and will be in many cases willing to just jump off the cliff when they are not ready. Having an outside point of view of your progress is necessary because self judgement is easily blurred by desire.

There is nothing magical about a year. Is a year sufficient but 364 days is not? Well if 364 days is ok then is 11 months ok? It is just a guideline and a way to just slow things down. Even this is not really standard everywhere. I have heard of the minimum 3 months before starting HRT and I have heard of wanting you to do RLE before HRT. I know some doctors do not want to do SRS until you have been on hormones for at least a year. That I can easily understand. The RLE seems to be in the spirit of getting a learners permit before getting the drivers license. No one wants to wait but it is a good idea.

I have also heard about time limits before BA. I am not sure but do you still need a letter for BA or does a legal name and gender change make this not necessary? There are hoops to jump through all the way and in some places they are different from others. Can you really say though, that there are not some out there who need to have the reins pulled back and be required to have the RLE before a major surgery? Yes there are some who likely do not need this, but judging from just what you see here on this forum could you in clear conscience say that unlimited access to SRS is a good idea?

[Kittie]

The purpose of it is to make sure you can function fully as a member of society in the gender role - socially, career wise. They are trying to ensure your safety and well-being, not end up ruining your life making snap decisions about irreversible changes. I tend to agree with Melissa in her last post - RLE by definition means living, working even sleeping in the gender role you're transitioning to - going out and actually pursuing that which you seek, not shying away from the challenge or staying in the closet at home playing a fantasy out in your mind. I started mine myself before even approaching my GP - my name was changed long before my first appointment at a gender clinic.

There is a lot more to living as a man or a woman than just how your external features look - you might be sure of what you need, but the people that can help are not going to take such drastic measures unless they are certain, that you are certain and capable of living.

[sandra-leigh]

How can one be living full time as a woman and yet not be out is beyond me, but I guess my idea of what a Real Life Experience is may be different than others.


Other than my mother and sister (who am I out to), I have not seen any of my relatives since my grandmother (mother's mother) died 5 or so years ago. The ones on my mother's side, I have not heard anything about since then. I am FB friends with some of my relatives on my father's side, but my cousins and I just don't seem to have anything to say to one another (not tension, just too little in common.) I am not in any regard "close" to anyone short of some of my second cousins: two of them and one or two third cousins are the only ones likely to care about me personally rather than thinking first about the "spectacle" or about how I am affecting the family name.

It is true that going through the... drama... associated with revealing yourself to your more distant relatives is one of the aspects of RLE. On the other hand, some here talk about "controlling the message" and not letting people know until necessary.

I already went through a time where I was cut off for 20 years by my father's side of the family, so it is not a big deal. The only one of them that I really missed, I am pretty sure will not cut me off.

Locally, everyone I am in touch with already knows me as Sandra, with the exception of my dentist (who has seen me dressed and has my meds list, but just hasn't been given the name.) I might also notify two ex-co-workers, one more for courtesy than anything else. My co-workers saw me with everything short of skirt or dress (and I never hid my bust from them.)

[Badtranny]

but do you understand that RLE is supposed to be about LIVING full time in ALL aspects of your life, with NO partitions?

Otherwise what would you be proving?

Note: I'm not judging your life, or transition, or your choices, I just don't want to see RLE redefined like we've redefined transition.

[emma5410]

I have a brother who cut himself off from the family 20 years ago. I have a sister who I loath (with very good reason but I will not go into that) who I have not spoken to in 10 years. They do not know about my RLE nor do the many distant relatives in the UK and Ireland. Not to mention any number of ex-co-workers. I have no intention of telling any of them because they are not important in my day to day life. I have no objection to them knowing. My list seems worse than Sandra-leigh's. As far as I am concerned I am doing RLE because I live as a woman 24/7.
I certainly agree with your point about redefining words.

[Angela Campbell]

My RLE will begin sometime after the first of the year when I can get the legal name change and gender markers all changed. At that point there will be no one I know who will not be aware that I am no longer going to ever appear to be a man again.

I will be Angela in looks, at work, at the bank, to friends, family, coworkers, enemies, the IRS, and Santa. There will be no hiding nor going back. Nothing less is full time and nothing that is temporary can be a RLE. It has to be all or nothing.

I am now preparing and working towards that point with a very detailed plan and no illusions.

[LeaP]

I'm not questioning the value of RLE, and I fully understand its purpose. My point is that the point has been lost - largely, if not completely - when the RLE that's to be used to validate your readiness for irreversible procedures is started with ... Yup, irreversible procedures! Doesn't anyone other than Misty see the irony in this?

Now you CAN make an argument on the basis of differences between SRS and, say, FFS, but you cannot do so without imposing a value judgement about the nature of the changes. Trying to differentiate them on the basis of permanence isn't very credible.

[Angela Campbell]

But the whole thing is irreversible. The act of going full time is the most irreversible of all. Once you come out and everybody knows there is no way to return to the before anyway. So the RLE is in itself what they are trying to protect you from.

[GirlieAmanda]

One can change every part of their body to look more feminine, but if they don't integrate into society well and have issues going through daily activities, it doesn't matter how much surgery one has. RLE is about LIVING in your new gender. RLE is supposed to make you get used to the idea of being you. Being trans doesn't happen in a doctor's office, it happens inside YOU. You have to be OK with it. I know a girl who got fairly big implants and then still presented as a guy for painfully too long. Some are on hormones for so long and look so obviously feminine, but still, they remain scared to integrate into society as their new gender. Living full time is a huge deal. It really means FULL TIME!. It's where the rubber meets the road.

[Angela Campbell]

Exactly!!

So to protect you from making a choice and get surgery no one is likely to see and can be hidden easily.......you first have to make a totally irreversible step and make sure the whole world knows, (even after taking on multiple non reversable procedures) which if you are not ready is much more damaging and life changing, to a person than SRS will ever be.

In other words, to make sure you do not get a vagina but still live as a man or somewhere in the middle of the spectrum, it is ok to add breasts - totally obvious not easily hidden - get FFS - same thing - and you must show the world what you are doing for a year. Do they check on you after the SRS and make sure you are still living your life the way they insist you do? Is living as a woman and integrating into society absolutely necessary if you have a vagina? I know some transmen who might disagree.

Reminds me of the laws requiring a waiting period before an abortion, or purchasing things we are not allowed to mention here. Big brother needs to make sure you do not make a "rash" decision....or is it because someone doesn't want you to do those things anyway?

Don't get me wrong, I intend to go by the book and do the RLE as specified, but I can also see the benefits and the uselessness of it. It is a good idea to me just because being on hormones for a year seems like a pre requisite.

Just playing devils advocate here.

[Kaitlyn Michele]

It is ironic Lea
Its just something on the long list of things that are messy about our situation. there is no perfect answer for something so destructive and risky (and so validating and life saving!!)

FWIW...my RLE started 2 months before my FFS.. I always felt in my mind that FFS (and my ensuing life being gendered correctly w/o question) was the conforming surgery... my penis was just there..
I took advantage of the rules at the time. I had no issue waiting the year (although I only waited the 12 months)

It's interesting to me that if person A has FFS and person B has GRS ...and they both realize it was a mistake... Person A, with the unmistakably female face and a penis could easily have a tougher time...i'm not saying Person B would not miss his penis, but no one would ever guess it was gone.. It could easily be argued that FFS should carry a requirement of RLE if your belief is that access to these surgeries should be subject to rule such as this one..

I simply do not believe in the idea of protecting people against themselves with rules and regulations except in extreme circumstances.. (like a psychotic person)
...I'm all for good support networks and being challenged by friends and therapists...but a one year rule? meh.. is one year even enough? and the whole idea of protecting ourselves against ourselves puts us in the same boat as the psychotic person.
we are viewed as someone that can't simply decide for ourselves.

I'll put it another way.. you either can or can't integrate well into society. its that simple, and its independent of your sexual organs. and if you can't integrate well into society as a woman, perhaps getting GRS to conform your body (regardless of the their gender role in the world) is the absolute best treatment for you...

how dare anyone lay claim to the idea that because they integrate well they are "allowed" to have this life saving surgery, and because you can't integrate this surgery is denied to you..

[bas1985]

This of course if we say that the person is able to decide for herself and able to PAY for herself.

I speak from a "social" view point, in the sense that a "normal" person could understand that the State will pay SRS (and maybe BA, FFS)
for a "real" TS who wants really to live as a woman, and not for a undecided person who simply does not want the penis but is unable
to decide to live in the gender role of people without a penis (generically speaking women... but of course there are FtM etc... but
I am speaking in general).

So... if the person pays SRS than it's OK, but in this case

a) we are perceived as a "strange" community, of people who mutilate ourselves without not a clear view of transition (some time ago there was a post of a person who was NOT a TS and wanted SRS. He was treated "badly" here, just for this point of view)

b) "poor people are not allowed to transition"... this is a title of a current thread. RLE is useful in countries, like Italy, where SRS is
payed by the state, in this case the state obliges to live as the target gender and I think that this is a sensitive requirement, in this
case only people who live as a woman get in the "free" waiting list. Others... well, maybe will pay for a psychiatric evaluation of GID
and fly to Thailand.

[Michelle.M]

You've had FFS, BA, orchie, and possibly additional plastic procedures performed?

So, in such a circumstance, what is the point of RLE?

I see your point and I love the question! But the rationale for RLE is spelled out in detail in Section XI in the WPATH SOC Version 7 (page 61 in the download I got from the WPATH website). In fact, Real Life Experience is a phrase we use; it's not even a WPATH term.

RLE and pre-surgery requirements are not necessarily the same thing. If one has FFS and backs out of transition, what's the worst that happens? He's an androgynous-looking man.


Using myself as an example, I started RLE with boobs and FFS. Which is Lea's point. Why should I wait a whole year to get the 'final cut".

Why indeed? Who says that you have to wait at all? There's only a 12 month RLE requirement if you're following the WPATH protocol. If you choose to follow the ICATH protocol you can have any hormones, procedures, surgeries or whatever as soon as you can find a provider who is willing to help you out. No referrals needed. But you'll have to find your own consenting medical providers, and good luck with that.

I don't actually advocate that, but for those who say that "the system" is holding them back or that they "have to" wait for this or that, well, it's just not true.

Now, if you're dependent on a payment system where someone else (or the government) calls the financial shots, then there's your answer. It's a financial (if not also a medical) gatekeeping system. Kinda goes with the territory, unless you're willing to write the check yourself.


How can one be living full time as a woman and yet not be out is beyond me, but I guess my idea of what a Real Life Experience is may be different than others.

I'm starting to think your idea is different. If by being "out" you mean living openly, completely and always as a woman, then that's just RLE. If you mean that RLE must include revealing one's transition and previous male existence to others, then I really can't see how that has anything to do with RLE.

I was RLE for a year before I came out to anyone, and even then it was only because I wanted to become more involved in effecting change in trans issues in my community and I felt that this would be better done if I came out from the shadows. But my RLE was quite successful up until then.


My point is that the point has been lost - largely, if not completely - when the RLE that's to be used to validate your readiness for irreversible procedures is started with ... Yup, irreversible procedures! Doesn't anyone other than Misty see the irony in this?

RLE is not necessarily an evaluation for one's readiness for irreversible procedures. It's to evaluate one's readiness to change gender roles. You can have all of those surgeries and still live as a man; you'd just be a man with some feminine features.

[Kaitlyn Michele]

....your last line Michelle......one of those feminine features could be no penis!!

I don't think RLE includes telling people you lived as a man in the past unless that's what you desire to do......only by leaving your prior life can you avoid this issue anyway...

as far as the gov't or the insurance paying Bas I hear you...

here in the united states I wonder as this becomes more medically accepted and insurable whether the standards for getting SRS will rise... it would probably still be worth it for people that can't afford it to wait longer..
and people that want it faster can just pay for it... that seems to make sense to me...

[Michelle.M]

....your last line Michelle......one of those feminine features could be no penis!!

Yeah, but . . . who would know, or even care? Sure, I wouldn't CHOOSE to be a man with no penis, but one could still live as a man regardless. Trans men do it all the time.


as far as the gov't or the insurance paying Bas I hear you...

here in the united states I wonder as this becomes more medically accepted and insurable whether the standards for getting SRS will rise...

That's kinda where I was going with that thought.

In the not-too-distant past we had a rigorous gatekeeping system for gender transition in the US that required that very strict social and gender norms be met before surgery. Although the SOC exists the gatekeeping paradigm is history, and as far as I can see everyone's glad for that. But that little bit of progress will likely be overcome by even stricter standards if GRS ever gets paid for by any kind of government benefit.

[LeaP]

I'll put it another way.. you either can or can't integrate well into society. its that simple, and its independent of your sexual organs. and if you can't integrate well into society as a woman, perhaps getting GRS to conform your body (regardless of the their gender role in the world) is the absolute best treatment for you...

how dare anyone lay claim to the idea that because they integrate well they are "allowed" to have this life saving surgery, and because you can't integrate this surgery is denied to you..

This is a good example of the kind of value judgement that is involved.

Michelle, RLE is for both purposes. From the SOC v7:



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

(The above is in the section entitled "Criteria For Surgeries" by the way.)

So the concern is surgery. The SOC essentially institutionalizes the value judgement that Kaitlyn describes so well. This despite the fact that WPATH, in the same document, ALSO recognizes that:



Surgery – particularly genital surgery – is often the last and the most considered step in the treatment process for gender dysphoria. While many transsexual, transgender, and gender-nonconforming individuals find comfort with their gender identity, role, and expression without surgery, for many others surgery is essential and medically necessary to alleviate their gender dysphoria (Hage & Karim, 2000). For the latter group, relief from gender dysphoria cannot be achieved without modification of their primary and/or secondary sex characteristics to establish greater congruence with their gender identity.

So by their own admission, WPATH "imposes" a requirement of a non medically-essential (if important) process for a medically-necessary procedure. It does so even though there is recognition of other risks associated with that delay for some.



... surgery can help patients feel more at ease in the presence of sex partners or in venues such as physicians’ offices, swimming pools, or health clubs. In some settings, surgery might reduce risk of harm in the event of arrest or search by police or other authorities.

I wonder if, from the perspective of SRS, RLE induces more issues than it prevents? Or whether anyone has even examined the question?

[Michelle.M]

. . . the concern is surgery. The SOC essentially institutionalizes the value judgement that Kaitlyn describes so well.

I don't think so. I don't want to sound like I'm splitting hairs, but IMO you put the emphasis in the wrong place:

This is the "why" -

"The criterion . . . that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity . . . that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role"

and this is the "when" -

" . . . before undergoing irreversible surgery."

And I agree that there's extreme concern about surgery, but it's from a doctor's professional perspective. It matters not a bit to any doctor if anyone has a successful RLE. The issue here is their own professional ethics (also addressed in SOC) and having an agreed-upon professional standard for care. In the ICATH protocol the professional and ethical requirement is met not by RLE but by informed consent. No RLE is involved, so RLE addresses no patient's surgical issues.

RLE is all about US, and the concern there is our own ability to adjust to and deal with living in our target gender.


So by their own admission, WPATH "imposes" a requirement of a non medically-essential (if important) process for a medically-necessary procedure.

Sure they do! Any professional (doctor, lawyer, accountant, whatever) won't put his or her professional reputation (and license to practice) on the line if the patient or client isn't willing to participate in the program. And WPATH seems to think this protocol is a pretty good one, and since there's quite a bit of agreement (or at least cooperation) among most, although not all, potential patients then they might be right.


. . . It does so even though there is recognition of other risks associated with that delay for some.

I wonder if, from the perspective of SRS, RLE induces more issues than it prevents? Or whether anyone has even examined the question?

Interesting question. What are your thoughts on this?

[LeaP]

I think there is logically some subset of the TS population who incurs some harm as a result of the requirement

Here are a few scenarios that come to mind:

The first is one where someone whose reluctance (or fear) to transition without SRS leads to them not transitioning at all or significantly delayed transition. Worst case, that could result in their suicide. One reason I think this is a real possibility is that, despite transsexualism being a lifelong condition, at the point which someone is finally addressing and resolving it, they are often either in crisis, or only shortly past one. Once the transition path has been started, many of us can testify to the spike in anxiety and dysphoria symptoms that crop up when we hit opposition, delays, and roadblocks.

Another is the arrest scenario mentioned in the SOC doc. The examples of being mistreated by police are legion. Many are roughly handled when discovered. Things get worse – far worse – with incarceration. I can see where this kind of concern might loom large for someone with a record and who is at a greater relative risk of arrest and incarceration.

Denial of emergency care is a real possibility. In one highly publicized case, the trans woman (Tyra Hunter) died when the responder refused to treat her after cutting open her pants and discovering her pre-op genitalia. The general issue of medical discrimination is huge. Have a look at this Huffington Post article: http://www.huffingtonpost.com/sunny-bjerk/when-will-transgender-new-yorkers-gain-acceptance-in-hospitals_b_3415304.html.

I am sure there are many other possible scenarios, but even these few suggest that the requirement causes some issues. The question is whether relatively more people are helped by the twelve-month requirement than are harmed by it.

There's another possible twist to this, though. It seems that most people who start transition actually do transition permanently. From the social transition perspective, then, you might infer that the twelve-month requirement for SRS simply doesn't matter.

But consider one alternative: What if the availability of SRS before going full-time reduced the percentage of transitioners? Would that be good or bad? Got me …

[Michelle.M]

But consider one alternative: What if the availability of SRS before going full-time reduced the percentage of transitioners? Would that be good or bad? Got me …

I tend to believe that this would directly contribute to a very high number of "regretters". But of course, there's no way we could possibly know.

[stefan37]

While RLE at first glance appears to be a roadblock, it will go fast. Changing your name and all your ids can take a couple months. In that time expect a tremendous amount of confusion and angst. Finances have to be arranged unless you are wealthy and can plop down at least 40k. Not even including electrolysis which takes forever, seems to never end and costs a small fortune. I could get my letters tomorrow if needed for srs. FFS is initially more important to me at this time. I would benefit from that more than srs. So in the meantime I have to deal with what I have. I would schedule ffs tomorrow, however I lack the funds, so I must continue saving until I can afford it. The major limiting factors to my physical transition are sufficient funds and timing. Due to the nature of my work I can only schedule operations early winter. In the meantime I have lots to work through as I shed my male persona and allow the inner me to emerge.

Having SRS now will not allow me to integrate any faster than I am already. Awful lot of theory-crafting floating around. Just do it and let it flow. Transition has to happen naturally and in its own time. Rush it and the consequences can be disastrous. There is much to unlearn and much to learn to integrate successfully. The awkward in between period develops the thick skin needed to successfully transition.

[Rianna Humble]

I think there is logically some subset of the TS population who incurs some harm as a result of the requirement

I'm sorry, Lea, I just don't buy your argument. If the requirement to live as a woman full time is too much for some people, what makes you think that it will be less arduous after they have had major surgery?

Yes there are always examples of discrimination but no they do not always depend on the other party looking at someone's genitalia.

The case that you mention of a medic or paramedic refusing aid based on their prejudice is a prima facie example of gross professional misconduct, but we should beware of saying that Transwomen don't need to live as women in case someone commits Gross Professional Misconduct.

I'm not sure what problem is making you argue so vehemently against the requirement for a woman to live full-time as a woman, perhaps we could be more productive examining what support we can offer with that problem.

[Michelle.M]

Having SRS now will not allow me to integrate any faster than I am already. Awful lot of theory-crafting floating around. Just do it and let it flow. Transition has to happen naturally and in its own time. Rush it and the consequences can be disastrous. There is much to unlearn and much to learn to integrate successfully. The awkward in between period develops the thick skin needed to successfully transition.

That's it! You've got it sussed. This is probably the best way to look at RLE and what it will do for you that I've ever heard.

[Kathryn Martin]

how dare anyone lay claim to the idea that because they integrate well they are "allowed" to have this life saving surgery, and because you can't integrate this surgery is denied to you..

There are two issues involved in making the RLE requirement necessary.

Firstly, The medical community operates under the maxim of "do no harm" which is interpreted substantially as meaning that the least invasive procedure while preserving patient life is the preferred one.

The first requirement to meet this medical requirement is to ensure that the surgery is being sought for the obvious reasons, sex change and is not influenced by significant mental health issues of the Axis 1 and 2 variety. Since depression is an Axis 1 illness and therefore gender dysphoria as well the surgeon requires assurances that the depression is circumstantially connected with the need for a sex change and the difficulties in attaining it.

The second requirement is to ensure that any improvement following surgery is in fact sustained. Part of that ( but not all of it) is tested by requiring the patient to transition before surgery and to demonstrate that the patient is capable of working, earning a living, interacting in their social environment and sustaining a life. In some countries which pay for surgery this can be up to two years, with clearance for hormones after one year. This has, albeit deficient, been attempted through RLE. In many cases this can be torturous especially when the transitioner is younger and wants to get on with their life. Another aspect of RLE is to see an actua;l improvement in the Axis 1 issues, for instance flushing out underlying problems in the event that the pateint has simply recited a learned narrative and thus manipulated the system.


This is a good example of the kind of value judgement that is involved.

I wonder if, from the perspective of SRS, RLE induces more issues than it prevents? Or whether anyone has even examined the question?

All of these questions including this one are central to developing eligibility requirements for publicly or insurance funded surgery. There are radical advocates for so called "informed consent model". This however does ot sit well with the medical service providers for the above mentioned reasons.

[LeaP]

I'm sorry, Lea, I just don't buy your argument. If the requirement to live as a woman full time is too much for some people, what makes you think that it will be less arduous after they have had major surgery?

...

The case that you mention of a medic or paramedic refusing aid based on their prejudice is a prima facie example of gross professional misconduct, but we should beware of saying that Transwomen don't need to live as women in case someone commits Gross Professional Misconduct.

I'm not sure what problem is making you argue so vehemently against the requirement for a woman to live full-time as a woman, perhaps we could be more productive examining what support we can offer with that problem.

Rianna, you are assuming way too much! I have no issue personally with RLE, and have every every intention of doing exactly that. That I don't have the kinds of issues I listed doesn't mean that they do not exist for others. They do. They have, in fact, cost some people their lives. Another way of looking at it for myself is simply that because I intend to transition anyway, it simply doesn't matter much to me. Different approaches to the same end, so to speak (pun intended).

Your own value judgment is contained within the quote above. It is the presumption that someone intends to live in the target gender and in the assumption that it might be "too much" for someone (as opposed to simply preferable). If someone does not intend to live in the target gender, then RLE forces them into doing something they would not, and should not do in order to obtain SRS.

Now believe me, I fully understand that this involves another kind of discussion. We have had debates over whether someone who does not intend to transition is truly transsexual. But putting that aside for the moment, if the need is to treat gender dysphoria with SRS, then transition might not be warranted in every case.

You are correct in stating there is a professional misconduct issue. You are incorrect in suggesting it is only a misconduct issue. The circumstances create the conditions under which the misconduct occurs. If you want to argue that that is necessary and unavoidable, that's fine, but don't dismiss such a deep and widespread reality. The circumstances (full-time and pre-OP) can be a problem trigger in many scenarios, so ignoring it as a potential problem in its own right makes no sense.

Its kind of funny that the topic raises concerns for me, when I am simply making observations. But I appreciate the goodwill, including your offer of support, Rianna.


There are two issues involved in making the RLE requirement necessary.

Firstly, The medical community operates under the maxim of "do no harm" which is interpreted substantially as meaning that the least invasive procedure while preserving patient life is the preferred one.



They do. Or at least they pretend to, and invoke this maxim when their own prejudices are in play. In a world of clean ethics and pure motives, RLE can be viewed as a less invasive first step. But when the medical community – even the very same surgeon – will do very invasive, irreversible procedures upfront? In that circumstance, I don't buy "less invasive" at all, and "do no harm" becomes highly suspect.

Steph, being dismissive by calling something theoretical is uncalled for. I raised a topic which by its nature is theoretical. The entire set of care standards is based in theory, the criteria for SRS most of all.

[stefan37]

It was not my intention to be dismissive, but if it was taken that way so be it. The criteria for SRS may be theory, but it seems to work in actuality. If one does not intend to live in their target gender, why even go through RLE or have SRS. I don't get this.

Could woulda shoulda. Sorry I am a contractor, I don't get bogged down thinking of all contingencies or scenarios. I will leave that to the beancounters. I formulate a strategy, develop a plan and execute it. Transition is not that much different. If one has no intention of transitioning all of this makes no sense to me. Permitting an individual to have srs when they plan to live as a male is a concept that is so bizarre to me. You need to transition? Then transition. Waiting a year for srs is hardly a handicap and if someone does not have the patience to wait as they are making progress, then they will have a difficult transition. Transition as you know is no game. Lives are at stake and many lose the battle. You want to discuss funding and the lack of that throws real roadblocks in front of many. That is a major anxiety stressor and Not having funds for procedure can lead to heavy depression and serious consequences. In many cases it will take a year between consults and scheduling surgery. There is much groundwork to be laid in that time. How comfortable are you using the woman's room constantly? There is a dynamic going on there that srs will not resolve. FFS is a much more valuable surgery to help an individual integrate while waiting for srs and that does not require a wait time other than the surgeons schedule.

Aetna's policy for instance if they do not specifically exclude transgender care will cover the surgery as a medically necessary procedure. However they require a 2 year RLE period. Want it faster find a therapist to sign off and pay for it out of pocket which most of us will have to do anyway.

[Kathryn Martin]

They do. Or at least they pretend to, and invoke this maxim when their own prejudices are in play. In a world of clean ethics and pure motives, RLE can be viewed as a less invasive first step. But when the medical community – even the very same surgeon – will do very invasive, irreversible procedures upfront? In that circumstance, I don't buy "less invasive" at all, and "do no harm" becomes highly suspect.

If you talk to serious endocrinologists, serious surgeons they all subscribe to some gate keeping. Plastic surgeons just cover their ass as far as SRS is concerned because it is standard practice and would net them too many law suits. You should have seen the waivers and caveats I had to sign. Anyone who has plastic surgery should have their heads examined (I mean that literally) before engaging in these types of procedures unless it is reconstructive after a major medical event or accident.

[Angela Campbell]

then it is a good thing I have had my head examined.

[sandra-leigh]

Which leads us back to the question of why natal women can get breast augmentation (any standard size) routinely, but a transsexual should (no exceptions provided for) need to "have their head examined"

[Kimberly Kael]

Which leads us back to the question of why natal women can get breast augmentation (any standard size) routinely, but a transsexual should (no exceptions provided for) need to "have their head examined"

There is a legitimate argument to be made that BA can create unique social issues for someone raised male who may or may not have practical experience living as a woman, don't you think? Then again, I tend to think the double-standard you cite is more of an oversight on the cisgender side of the equation than a gross disservice on the trans side, but that may just be me.

[Michelle.M]

Which leads us back to the question of why natal women can get breast augmentation (any standard size) routinely, but a transsexual should (no exceptions provided for) need to "have their head examined"

Huh? I didn't need any referral or therapist's letter for my BA. Nor for my FFS. Why would anyone need to have their head examined for wanting to improve their appearance?

[Kathryn Martin]

Sandra you just assumes I was speaking of trans people only. I think everyone should.....

[sandra-leigh]

Michelle: Kathryn had posted,


Anyone who has plastic surgery should have their heads examined (I mean that literally) before engaging in these types of procedures unless it is reconstructive after a major medical event or accident.

and has now clarified the point to be clear that her "Anyone" includes everyone, trans or not.

I do not seem to follow Kathryn's reasoning on this matter, so I do not know why (etc.) "for wanting to improve their appearance". Perhaps because of the medical risks and the way that the medical industry requires that responsibility for faults be signed away??

[LeaP]

I can think of any number of arguments for why it might be a good idea. But I also think that line of thinking feeds the mentality of accepting and living with what you were born with. It's difficult to argue congruence for SRS but exclude FFS when it is clearly so affirming to some, for example.

Back on topic, let me ask a question, speaking to the topic in another way:

The premise - FFS is highly invasive and effectively permanent. Hormones, taken long enough, result in permanent changes. Social transition results in permanent effects to life, even if unwound. As an invasive process with permanent effects, SRS is in he same general class as the others. So much so, in fact, that the original gatekeeping approach allowed none of the above until completion of RLE.

Nonetheless, people do go ahead with much of this at (or near) the start of social transition these days.

The question - Given the above, if the notion of RLE had never been invented by the gatekeepers, would it occur to you to impose it? Or would you simply approve going ahead with transition?

[Michelle.M]

The question - Given the above, if the notion of RLE had never been invented by the gatekeepers, would it occur to you to impose it? Or would you simply approve going ahead with transition?

Oh, now THAT's an interesting idea! Good question!

I think we've all been conditioned to accept RLE as the standard (and for the record, I endorse it). But if we had never known this as a standard then why would anyone impose it? The paradigm would be the reverse - immediate transition would be the norm and RLE would be seen as a delaying tactic. Instead of a chorus of "What's your hurry?" we'd all be asking "What's holding you back?"

If that were the transition standard I think we might actually see fewer regretters who wouldn't transition for fear of the suddenness of the change.

I tend to think regretters have a variety of life skills issues, indecision being one of them and the willingness to tackle the real issues in their lives being another. Rather than arrive at surgery over a period of time, unprepared for not having done their gender transition homework they might not even begin for fear of having to make a decisive move.

And the lack of roadblocks would encourage others who really needed to make a gender transition to decisively and deliberately do so.

[Kimberly Kael]

The question - Given the above, if the notion of RLE had never been invented by the gatekeepers, would it occur to you to impose it?

If there aren't gatekeepers then by definition it isn't being imposed. In practice, as many have pointed out, it's not hard to bypass the guidelines. Particularly if you're well off. Would I still advise RLE? Absolutely. I'm sure I had other options and I never once seriously considered them as a starting point.


I tend to think regretters have a variety of life skills issues, indecision being one of them and the willingness to tackle the real issues in their lives being another. Rather than arrive at surgery over a period of time, unprepared for not having done their gender transition homework they might not even begin for fear of having to make a decisive move.

And the lack of roadblocks would encourage others who really needed to make a gender transition to decisively and deliberately do so.

... successfully? That I'm much less convinced about. I suspect many regretters' life skill deficits have more to do with setting realistic expectations of what surgery will do for them. It's not a magic wand that addresses everything that feels unfair about life, and honestly I've seen more than a few who seem to believe otherwise.

[LeaP]

I am so happy that you mentioned the aspect of following an existing standard, Michelle. I had that in mind but did not want to suggest it myself, biasing a response.

What ever you think of its value, the standard does carry some implications. One is seen in our constant debates about real versus fantasy transsexuals. The issue here is not knowing who really is transitioning, who intends to, who might, when they might do it, etc. A point in time transition decision removes a lot of ambiguity.

I think the aspect of defending the standard is also manifest in the magical quality that is sometimes granted the one year mark. How so? By questioning people as time goes by. Not 12 months yet? No problem. Hit 12 months? "So, when do you plan on…?" Two or three years go by and the judgment is "oh, she's stuck." Yessiree, there is a lot of potency in that twelve-month standard.

Would there be more regretters or fewer? I don't know. There are some many ways of looking at that question. Some talk about the slippery slope biasing toward transition when hormones are started. The suggestion underlying the comment is that perhaps the person should not be taking the hormones because they are not a transition candidate. To the extent that is true and such people transition, that is certainly one potential source of regret. If all-in-one transition were to become the norm, on the other hand, I can easily see where it would require a different approval regimen – and that might incur more delay anyway. I think most of us, with the exception of the radical types Kathryn mentions, would not recommend an informed consent-only model.

[Michelle.M]

I suspect many regretters' life skill deficits have more to do with setting realistic expectations of what surgery will do for them. It's not a magic wand that addresses everything that feels unfair about life, and honestly I've seen more than a few who seem to believe otherwise.

I've never heard of a regretter who was actually trans to begin with. In other words, they didn't go into GRS to achieve gender congruence but rather they were looking for something to fix a problem they couldn't (or wouldn't) identify or to fulfill a fantasy. So in that sense, you're probably right.


I think most of us, with the exception of the radical types Kathryn mentions, would not recommend an informed consent-only model.

I don't know if informed consent is radical; it's just different. Remember, this site is heavily geared towards the WPATH protocol, and anyone who wanders in here who endorses informed consent usually gets run out of [virtual] town.

Yeah, it happens.

Informed consent is fine for some who have very well-defined goals and few, if any, concurrent issues. But that also assumes the transitioner can find a surgeon who is on board, and that alone makes the informed consent protocol hard to follow.

[Kathryn Martin]

Before I can answer this question I would have to know who is asking it. But no matter who is asking it there is an analysis and it goes like this:

I am a girl. My body is not a girls body. I am a freak, it's all in my head, oh my god how can I fix my head. I find out there is no head fix. Everyone sees my body but no one sees inside my head. WTF do I do now. So am I a girl or am I a boy what trumps here? Body or brain?

Brain makes me see the world in a particular way, so maybe I need to fix my body. I find out there is a body fix. Hormones and surgery.

I go to see a doctor, who says: I can't see inside your head but your body tells me you are a boy. Let's do some bloodwork. Bloodwork comes back normal, doctor says it's all in your head, sorry. I insist I am a girl. Doctor says well I can't test if you are just making it up. So show me, because I am not going to give you drugs willy nilly and cut of body parts just because you say so. So show! you show me that you are a girl and I will consider it. I say, ok, I'll show you. And there is RLE freshly minted awesome RLE because if I show him he will believe that the inside of my head looks the way I say it is.

Yup, I would have come up with that one .....

[LeaP]

But you didn't, Kathryn. You started hormones before RLE. So from YOUR perspective, there was no issue. What the doctor wants for reassurance is a different question.

Should I take your point about knowing who is asking to indicate that what was good for you might not be good for another?

[sandra-leigh]

I do not have any personal experiences with the topic, but please have a look at this recent article (http://www.transadvocate.com/transitioning-back-to-ones-assigned-sex-at-birth.htm) in transadvocate on the topic of transitioning back:


I had an appointment with my own therapist, Patricia Wojdowski, L.C.S.W., on Wednesday. While at the appointment, I asked her some questions regarding detransitioning, and asked if I could post her responses at Pam’s House Blend.

I actually was kind of surprised at Patricia’s answers. Basically, in her long practice with trans clients (she’s been involved with studying and treating transsexuals and other gender variant people since the mid-seventies), the single commonality for all of her detransitioning clients has been that external pressures were the impetus. All of her clients who have detransitioned still considered themselves as having a gender identity that didn’t match their natal sex, but external pressures — issues such as inability to find employment, biases and discrimination in the workplace, an inability to find appropriate housing, conflict with friends and/or family, etc. — are why the RLE is evaluated by the client as unsuccessful, and the client decides to detransition.

I know there are other reasons than the ones my therapist cites. Sometimes the reason is relating to faith, where one becomes an “ex-transsexual” or “ex-transgender” (the trans equivalents to “ex-gay”). Sometimes it’s because the person really isn’t a transsexual, and an unsuccessful RLE catches them before they experience transsexual regret. Since my therapist doesn’t practice conversion (or reparative) therapy, she wouldn’t see those who are detransitioning for reasons of faith. But, it is interesting that in all the years of her practice, she’s never seen a transsexual who has detransitioned due to because the detransitioner has figured out that he or she really wasn’t transsexual — all of her detransitioners have detransitioned due to external pressures.

The article also has some relevant information about what RLE is:


Page 17 of the Harry Benjamin Standards Of Care For Gender Identity Disorders says this about the RLE (emphasis added):

The act of fully adopting a new or evolving gender role or gender presentation in everyday life is known as the real-life experience. The real-life experience is essential to the transition to the gender role that is congruent with the patient’s gender identity. Since changing one’s gender presentation has immediate profound personal and social consequences, the decision to do so should be preceded by an awareness of what the familial, vocational, interpersonal, educational, economic, and legal consequences are likely to be. [...]

Real-Life Experience versus Real-Life Test. Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person’s responsibility. Some begin the real-life experience and decide that this often imagined life direction is not in their best interest. Professionals sometimes construe the real-life experience as the real-life test of the ultimate diagnosis. If patients prosper in the preferred gender, they are confirmed as “transsexual,” but if they decided against continuing, they “must not have been.” This reasoning is a confusion of the forces that enable successful adaptation with the presence of a gender identity disorder. The real-life experience tests the person’s resolve, the capacity to function in the preferred gender, and the adequacy of social, economic, and psychological supports. It assists both the patient and the mental health professional in their judgments about how to proceed. Diagnosis, although always open for reconsideration, precedes a recommendation for patients to embark on the real-life experience. When the patient is successful in the real-life experience, both the mental health professional and the patient gain confidence about undertaking further steps. [...]

With regards to some points that were raised earlier in this thread: notice the HB talks about "adopting a new or evolving gender role or gender presentation in everyday life". My relatives that are not in my immediate family are not part of my "everyday life": I have seen them only twice in more than 20 years. My friends Back Home are not either; I see them at about 2-3 year intervals now. My friends where I live now all know me as Sandra, as do my doctors and all my regular appointments.

Changing my name legally will make a difference, but the difference will be mostly for myself; that and my mother and sister and spouse. And those are important people, to be sure. But even without a legal name change, I am effectively RLE already.

[LeaP]

I've never heard of a regretter who was actually trans to begin with. In other words, they didn't go into GRS to achieve gender congruence but rather they were looking for something to fix a problem they couldn't (or wouldn't) identify or to fulfill a fantasy.

There have been examples of this in the forum. One described the failure of SRS to achieve the desired change. I.e., the procedure "failed."

Topic note - it's hard to talk about procedures, particularly SRS, as separate from RLE. But they ultimately ARE separable. It's possible to conceive of surgical approval protocols that make no mention of social transition (experience, test, or anything else) whatsoever, leaving that as a matter solely between patient and therapist, for example.

Consider that some maintain that the state of your genitals is irrelevant. Is that consistent with a position of imposing RLE before SRS? Or is it more a matter of buying into the almighty penis - that it doesn't matter as long as the genitalia are male?

[Kathryn Martin]

I don't know if we are speaking of the same person but with reputable surgeons there are no failures of the procedure. There are failures of the aftercare, usually not during the supervised recovery period but rather when things are not done by the book. Such simple things as not properly dilating etc. can very well lead to a non-functioning vagina. Of course people love to blame those that "should have provided the care" but really. Health is, after all first the patients responsibility. The funny thing (and somewhat crude) is that even a perfectly working vagina does not get you a partner. So what is the desired change occasioned by the surgery? A well functioning, fully orgasmic vagina. It's not going to make you a woman, it doesn't get you a sex partner, but it makes you whole. Oh and a surgically constructed vagina does not make you a woman.

Damn, you edited while I was typing. Not sure buying into the AP? Can you clarify?

[Michelle.M]

With regards to some points that were raised earlier in this thread: notice the HB talks about "adopting a new or evolving gender role or gender presentation in everyday life".

OK, then! This is very helpful. Thanks for broadening my perspective on this.

[mary something]

I don't know if we are speaking of the same person but with reputable surgeons there are no failures of the procedure.


really ?

[Kathryn Martin]

really ?

Yes quite literally. Most surgeons will not undertake the surgery of there are organic deficiencies etc. They will tell you up front. I looked around and tried to find "botched surgeries" that resulted from a skills deficiency by surgeons. Some obscure names came up. The actual procedure is pretty straight forward.

The trouble always comes in the aftercare and most often after the patient is released home.

[LeaP]

Strictly from the perspective of medical risk and results, that would argue for SRS to be relatively less regulated than FFS and BA. Cosmetic procedures are performed by a very large number of surgeons. They vary widely in skill and experience. There is more opportunity for unpredictable or unsatisfactory results. There are many stories in the news about botched procedures, loss of function and sensation, tissue damage and loss, infections, scarring, disfigurement, and much, much more.

[Angela Campbell]

So....if RLE is so important then why is there no mention of the standards of what RLE is? The therapist and psychologist will write a letter after a year of RLE, but how do they know other than what you tell them? There is no mention in the WPATH SOC about the requirement to change your name and gender legally, just to live as a woman for a year. No proof required, no rules which constitute what is required to be considered RLE.

So if you sit in your house and never leave it except for the occasional trip to the therapist is it just a game of waiting until a year has passed since you met the therapist and stated you were living as a woman? Do they hire a private detective to follow you and report? Is it really just saying that at least a year ago you told a therapist you were a woman and wanted SRS, and a year later you still want it?

Yes most of us will gladly be living as a woman as fast as they can but how do they know?

[LeaP]

It's an interesting point, Angela. Especially since the standards of care recommend, but do not require ongoing therapist visits. Theoretically, the therapist (and the surgeon) are on the liability hook. But the reality is that actual verification would be difficult under the current approach.

[Angela Campbell]

So that means there is no real RLE required just a waiting period, making it pointless as a requirement. No better than a suggestion.

[Frances]

So people want to transition without living in the target gender? I don't get that.

So-called gatekeepers do no more than observe people over a period of time. Not by following them, but by listening to them. Do people make up stories about going to a non-existant workplace or meeting non-existant friends? What's the point? The transitioner has to report his or her real life experience to a therapist who makes decisions based on the patient/client's ability to cope with real life. Having facial surgery does not count has real life experience. Lots of men look like women.

[Angela Campbell]

The point is that a person is either going to live as the preferred gender or they will not and the therapist has to take their word for it just the same as taking their word for being a woman inside. Why does a year of the same insistence make any difference other than waiting or testing resolve?

Well you can have SRS but you reallllllyyy have to want it!

All it means is someone is stubborn not actually a transsexual. A RLE does nothing to determine that..

Do people want to get SRS without living as their target gender??? I doubt it but RLE is designed on the assumption that they do.

Keep in mind I am playing devils advocate here and I do intend to live a RLE. As soon as my name is changed I will do RLE for the rest of my life.

There was a time when you must be attracted to only men and had never been sexually excited by wearing womens clothing in order to be approved for SRS. This was in order to keep anyone who is not really a transsexual from having the surgery. It didn't take long for many to learn this and tell the therapist what they were expecting to hear so the practice was changed.

[Frances]

But why undergo a therpeutic process without being honest about everything? Among the criteria for GID is persistence. A therapist can see through BS real fast. There seems to be two issues here. Some people wanting to forego the RLE and physically become women without seeing if they can function as women, and the usefulness of the RLE if it's possible to lie about the experience. Like someone said earlier, why become a woman if you don't want to live as one, and how can lying be a good idea with life and death issues? Long-term therapies aim to minize regret and maximizes chances of success, not frustrate men with TS fantasies. It's not a game.

[Angela Campbell]

The discussion is on whether or not RLE makes sense and my point is that although from my point of view it is something I want to do, I already went through a lot with someone I am paying to help me through transition and I intend to work through the plan we made. There are no issues here and no one is saying they want to forgo the RLE and physically become women without seeing if they can function as women.

from a clinical view of gatekeeping it is not going to do the job intended. Will it stop a cd with fantasies....not if he is determined it won't.

RLE in present form does not determine if someone can function as a woman

But then it is ok and accepted to make yourself look like a woman everywhere but between the legs and you do not need to be able to prove you can function as a woman to do that........

[Frances]

The gatekeeping style is about prolonged intensive therapy. Why would it not do the job intended? I may be missing something. What is the intended job in your opinion?

RLE helps the therapist determine if the patient/client can function as a woman. Maybe it's an American thing I don't get. Doctors (therapists, endocrinologists, surgeons) determine if you should medically transition, not you. Would you go ask for chemo or an amputation and expect to get it? Why should this be different?

[Kathryn Martin]

It's an interesting point, Angela. Especially since the standards of care recommend, but do not require ongoing therapist visits. Theoretically, the therapist (and the surgeon) are on the liability hook. But the reality is that actual verification would be difficult under the current approach.

Except that you require two letters of which one should be from your therapist and one from an independent therapist who is consulted for surgery only. In order to form an opinion your therapist requires you to attend and actually report on your transition. I had a bit of an eye opener when I read my clearance letter from my therapist. It was long, detailed and very carefully written with very explicit language addressing every one of the requirements for a formal diagnosis and exclusion of Axis 1 and 2 mental health findings. The results contained a careful medical anamnesis, a description of my my RLE experience and observations of the therapist in detail of me and from other sources. As far as verification went, everything was supported by sources outside of my own narrative. I believe that is the standard.


So that means there is no real RLE required just a waiting period, making it pointless as a requirement. No better than a suggestion.

see above! if you have a reputable therapist who knows what they are doing (don't forget this is akin to a medical legal report that can have significant legal consequences even if there are patients and therapists that are not aware of this) then this is everything but a waiting period.


So people want to transition without living in the target gender? I don't get that.

Frances, you know, look like a girl, act like a girl, keep your penis, call yourself a lesbian, use the women's washroom.... etc. what do you call that again?

[Angela Campbell]

Some therapists work that way and many do not. They should. Mine does not require me to make any more visits unless there is something I need to discuss or until it is time to go to the second one (his partner although in a different office) for the letters when the time comes. No requirements for ongoing therapy.

[Frances]

Then chose one who does. Why take this lightly? I have seen way too many people mess it up. I am completely for gatekeepers and strict protocols.

We may not be talking about the same thing exactly.

[Angela Campbell]

I have chosen the ones in the area with the most experience and specializing in transition. I was diagnosed by another independent psychologist. I will stick to this as it is working out very well.

I too have seen several who "messed it up". Not because of failure to do RLE but because of poor or no planning and not doing the hard work to ensure things go as planned.

[Frances]

I have a feeling some people in this thread do not know what the RLE is and what it entails.

[Michelle.M]

Frances, you know, look like a girl, act like a girl, keep your penis, call yourself a lesbian, use the women's washroom.... etc. what do you call that again?

And there it is! The one true path to a viable and authentic gender transition. Also known as transmisogyny. Non-ops and transbians, please exit now and don't come back.

Crikey!

[Kimberly Kael]

And there it is! The one true path to a viable and authentic gender transition. Also known as transmisogyny.

Not to mention heterocentrism. Insisting that there's one true way to be plays to a world view that doesn't include transwomen at all, so it's ultimately self-defeating.

[Beth-Lock]

The gatekeeping (by means of RLE)....(is) therapy. Why would it not do the job intended? I may be missing something. Maybe it's an American thing I don't get. Doctors (therapists, endocrinologists, surgeons) determine if you should medically transition, not you.

Yes, American medicine is more client centrered and dominated by individualism. Frances is generally, I think an individualist, taking in that way after her father, but she is more level-headed on the topic of transition. I have observed though, in general, a lot of transsexuals were mavericks or troubled by non-conformity, acting out rebellions in their younger years. Perhaps it is not surprising, when planted in the American cultural soil, this leads to scoffing at even the authority of those trying to help them, in the helping professions that guide one towards sex change, or in some cases, maybe a better alternative. Both Frances and myself sought therapy without having transition in mind as the only outcome.

In my case, even way back when I repressed being trans, I fantasized about such things as hospital controlled, in-patient RLE. And I do not mean forced feminization. I don't think that was a fixation on the process, but a longing for a socially acceptable route to full transition.

[Badtranny]

I have a feeling some people in this thread do not know what the RLE is and what it entails.

Francis, don't be so rigid. Ms Paige is trying pretty hard to agree with you, but she's also pointing out that the vaunted RLE is increasingly getting the short shrift from the psych community. She herself is not cutting corners or even advocating it, she's simply stating some facts about a modern transition. My doctor would point me to people who would write whatever letter I needed because it is his contention that people are gonna do what people are gonna do.

RLE is still a requirement but I'll wager that it won't be in 5 years. We have people on this very forum going through closeted transitions and it wouldn't surprise me if there were a few that have already had the miracle of SRS yet still live as men. This is just what's going on now, and it's not Angela's fault, ;-)

...and Kathryn, I may look like a girl, act like a girl, use the women's restrooms, and still have my penis, but I'm certainly not a lesbian. I just don't swing that way, ...no offense.

[Beth-Lock]

...the vaunted RLE is increasingly getting the short shrift from the psych community. RLE is still a requirement but I'll wager that it won't be in 5 years. .

I am not sure how far it has gone in Ottawa, but RLE is no longer seen as strictly necessary, or at least not 2 years of it.


We have people on this very forum going through closeted transitions and it wouldn't surprise me if there were a few that have already had the miracle of SRS yet still live as men. This is just what's going on now....

Ditto here. Sill, I have several concerns. The traditional process leading to SRS had its own face validity, that is, it seemed to many in the public, to make sense and be justifiable to the point they could tolerate it, if not exactly support it, that is, as handled the way it used to be handled.

Second, is the reflection of transhumanism (a great variety of bodily modifications, some bizarre), on sex change. The radical and even, bizarre sorts of body mods will shock many. (See the thread on that.)

And finally, the trans community has not come to grips with the prospect of HRT being denied most or all of the time, due to its medical risks. There seems to have been a sea change in how HRT is percieved by medical doctors. In other words, from being pro-HRT, and easy about prescribing it, now the bias is towards anti-HRT. My family doctor when I raised te issue of HRT, said she is taking women off it rather than putting them on it these days. The doctors do not know if its dangers are merely underestimated, like smoking once was, or more serious, and not recognized, like thalidomide, yet negative news suppressed by some in the drug industry.

As someone said, the trans business is itself in transition these days and of course, that sort of revolutionary change always creates problems for some, being difficult to adjust to. And will there be a public backlash? .

[sandra-leigh]

According to the article (about detransitioning) that I cited earlier (http://www.transadvocate.com/transitioning-back-to-ones-assigned-sex-at-birth.htm), WPATH includes this on RLE:


Health professionals should clearly document a patient’s experience in the gender role in the medical chart, including the start date of living full time for those who are preparing for genital surgery. In some situations, if needed, health professionals may request verification that this criterion has been fulfilled: They may communicate with individuals who have related to the patient in an identity-congruent gender role, or request documentation of a legal name and/or gender marker change, if applicable.

Thus there is provision for "checking up" on the RLE. On the other hand that checking is not mandatory, so potentially a really good BS'er could convince a therapist that RLE had happened.

[Angela Campbell]

Sandra, that is the thing. It is a "suggestion" like everything else in the SOC. It is up to the patient in the end. As Melissa said I do not advocate bypassing the standards. To me this is a serious decision and I want to make it go as well as it is possible to do. So far it has gone very well. I just point out that RLE is not a cure all or end all and in some cases not even needed and even can be detrimental. In the end YOU are responsible for the decision. A therapist or Doctor can only guide you and assist if you let them, but it is all your decision and all your doing.

I am living as a woman now with the exception that some at work do not know. Even at work the only thing different is my name and the lack of makeup. The uniform is the same for men and women, they do not even make the shirts in women's sizes. I wear women's pants and shoes now and have for some time. Ok I also have my eyes on some safety shoes with pink stripes on them, lol.

I intend to apply for my name change at the first of the year, and will schedule my FFS and BA for the same week as the court date. After a few weeks off at work I will return as Angela forever and my RLE will begin. About a year after that I will make a trip out to Thailand.

So if I did things differently such as having the SRS 3 months after the BA and FFS would that cause a problem in which I would end up de transitioning? Will having BA and FFS with no year of RLE really cause a problem?

As it stands now, there is a minimum period of at least two years with the consistent desire to transition and live as female (in my case 50) then a minimum of 3 months of therapy before beginning HRT. Then a year of RLE before SRS. Then you are on your own with no more requirements.

Perhaps the wait is too long, but could it be that the bigger cause of a failure may be the "on your own" afterward? Perhaps more attention needs to be spent on the after transition care. That is tough because there is no more carrot hanging from the stick. At this point it really is all up to you.

[Kathryn Martin]

And there it is! The one true path to a viable and authentic gender transition. Also known as transmisogyny. Non-ops and transbians, please exit now and don't come back.

Crikey!


Not to mention heterocentrism. Insisting that there's one true way to be plays to a world view that doesn't include transwomen at all, so it's ultimately self-defeating.


...and Kathryn, I may look like a girl, act like a girl, use the women's restrooms, and still have my penis, but I'm certainly not a lesbian. I just don't swing that way, ...no offense.

Nice, but for the context in which I made that comment which was:

So people want to transition without living in the target gender? I don't get that.


Do you, sometimes in the middle of night wonder how bizarre some of this stuff is? Does it occur to you that what you are defending is the emperor in his new clothes? No amount of make belief will overcome some fundamental truth. Transmysogyny and heterocentrism? Think about the person who wants to transition but not live in their target gender? Or the trans-woman with a penis who propositions a lesbian. Or the whole nonsense about the cotton ceiling. Or the activists who complain that lesbians are not interested in in trans women.
We have a thread on this forum where someone seriously suggest that maybe transitioning without coming out at work is a valid way to transition, or the underlying inference of the some of the comments in this thread that RLE is not necessary. Do you sometimes step back from your fervent defense of make belief and see the reality that the emperor is actually naked?

Angela says:


Perhaps the wait is too long, but could it be that the bigger cause of a failure may be the "on your own" afterward? Perhaps more attention needs to be spent on the after transition care. That is tough because there is no more carrot hanging from the stick. At this point it really is all up to you.

What then is the carrot? Why do you think the real work begins after SRS as so many of the post ops have talked about. Is the carrot to look like a woman or to be whole, maybe for the first time in your life. How then do you integrate into womanhood? Do you think a therapist can therapeutically make you into a woman? So many transwomen end up in the no-mans-land after the the bridges are burnt and never reach the shining city of womanhood. Eventually they give up and end up searching for partners and often finding them from others stuck in the same place. The work to traverse this no-mans-land and make it out of there is much harder that anything you might have experienced in transition. Because it is subtle, it's invisible, and it is eerily like groping in the dark. Sure everyone (hopefully) by now calls you by your right name and does not mis-gender you. But wait for the subtle undercurrent of uneasiness, the almost unnoticeable falling quiet over subjects you are presumed not to understand, and the fresh faced patting of your arm with the unspoken amusement flittering across the faces. How are you going to deal with this. Frances spoke about persistence, I would add patience and utter determination. RLE is not only something for the assessor of your transness. It is for you, to test yourself against a reality of experience.

By the way calling me a trans misogynist is another example of Goodwin's law. I wonder when the Nazis come out.

[Angela Campbell]

The carrot is the approval letters they use to make sure you go according to plan. Some are clearly doing what is required to do to get what they want. Gatekeeping seems to invite this.

And no I do not think the real work begins after the operation but it surely does not end there either. I have been doing hard work for some time and haven't even started my RLE yet.

[bas1985]

Just for reference I translate in English the RLE definition in the Italian Standards of Care for Transsexualism...

I think that the accent is put on the REAL world and that a transition without a test is meaningless.

----


The RLT. The Person, with psychological support, generally as soon as HRT is begun, starts to live in the world as a person with the sex she-he feels to own, adopting the role gender in terms of dressing, behavior, expression, etc...

This phase is strongly auto-diagnostic, as through it the person must show to him-herself and to others that he-she is able to live in real world in the chosen gender, experimenting honors and duties and not only the stereotype ones.

[Michelle.M]

Or the trans-woman with a penis who propositions a lesbian.

And the hits just keep on coming!

Kathryn, you have a very narrow and rigid view of what a trans woman is, how she should live and how her body should be configured. You've expressed those views time and again, and you always act surprised and defensive when your views are challenged.

Denying the validity of someone's gender self-identification for the configuration of their body is transphobia. You do that.

Belittling other trans women for having attitudes and living in ways that you find inauthentic is transmisogyny. You do that, too.

You can defend your views, but you already know that people will just pile on. I'm sorry to see that happen, but you're not actually surprised at that, are you?

[stefan37]

I just do not get this thread. It is an interesting exercise of different viewpoints and how others see RLE with a lot of theory thrown in. I legally changed my name late summer and went full time this fall. I could get the necessary letters needed for surgery tomorrow if I wanted. Would srs or even ffs magically allow me to integrate. I think not. Maybe if I was 30 or 40 years younger. It takes time to get the paperwork in order after a name change, certainly longer than a couple months. By the time you feel comfortable in your target gender, lost the majority of your male mannerisms and feel comfortable as woman will take a long time. Like Kathryn I said earlier I do not get the point of transitioning in the closet. Isn't the goal to live as your target gender 24/7. Transition by its very nature is a public process. If you are afraid to show the world your inner self why transition. But then again as this thread reveals we have many viewpoints on what is transition.

If hrt solved my dysphoria and I was able to function in life as a male, my life would not be so disrupted and the RLE would be a moot point. Same if you want to transition and continue to work as male. There would be no point to RLE. I wonder how many here dismissing the value of RLE have cleared their facial hair sufficiently to go full time without noticeable beard growth. Hell some have just recently started. There is much legwork involved in changing to your target gender and SRS surgery will not speed the process. Only by living 24/7 in your target gender will successful integration be possible. As I was talking to a friend of mine last night I have 55+ years of male socialization to unlearn and similar to cramming for a test jam those lost years of learning female socialization into a very short time frame.

[Marleena]

I just do not get this thread.

I don't either! It's turned into an opportunity to insult other people who are struggling or are dealing with their issues differently than some other individuals expect. I'm taking the chance of being called dense by even replying here.

[Kaitlyn Michele]

Actually purely as a technicality Kathryn has lost the argument.
Godwin's law is specific that invoking the term Nazi ends the argument and the person that brings it in is the loser.
Unless of course you can demonstrate that the term transmisogyny is equivalent to being either Hitler or a Nazi.


I actually think comments that include ideas such as "half transition" or RLE followed by the words "except for _____" are nonsense... but this is a communication issue. I recall years ago sitting in a group meeting and saying "I am changing into a woman" and I left the meeting bruised and battered...I was chewed up by two militant old ladies..I communicated better from that point...and that was maybe 2 years before I started hormones..i had to grow and learn a lot in the meantime.. other times I was called an idiot for having no plan, and I was repeatedly admonished to not transition, for choosing transition over my career, and for choosing transition over my kids..(as if that was what I was doing!!!...ugh)....

in one way I guess they did me a favor, my resolve firmed, and I did what was right for me (including to keep this on topic getting ffs almost immediately after starting "RLE")
and I really think Kathryn you are coming from that place in your comments..
..but I think you go to far... I think you overstate the implications of not "going all the way"

... I actually agree with some of the things you say
I am a huge proponent of SRS to help us feel right with ourselves and that people skipping it do not know what they are missing (assuming they are women)
...I believe if you have a dick, stay out of my locker room for example...I don't hate you for having your dick, but I do believe the cost of doing business includes some things you may not like...and I also believe that it should be no big deal to you and your dick
..I believe if you are a woman, and you spend your life trying to fight it, you will ultimately fail and at the end you are going to regret your life and be very sad about it...its going to suck for you...sorry but as I get through middle age, I know too many of these people...and I've yet to meet the happy as a clam 65 yr old non transitioned ts woman...

if you insist you are a woman when you are not, I feel sorry for you that you would actually want to feel that way or have tricked yourself into feeling that way...sometimes it feels bad to me because solely on a personal and selfish level, I know what I went through to get to this place, and it bugs me ..but so what....it bugs me...what the heck does that matter..i didn't win any contest, I didn't get a prize that you are taking from me...and maybe even my pity is misplaced...if you are happy..then you are happy!! how is that NOT a good outcome..

anyway...Kathryn has officially ended the argument..and purely on a technicality lost it as well...I close my case..

[mary something]

Yes quite literally. Most surgeons will not undertake the surgery of there are organic deficiencies etc. They will tell you up front. I looked around and tried to find "botched surgeries" that resulted from a skills deficiency by surgeons. Some obscure names came up. The actual procedure is pretty straight forward.

The trouble always comes in the aftercare and most often after the patient is released home.

That is simply not true. Even a simple surgery such as a gall bladder removal carries inherent risks that can result in death in a statistically small series of patients.

Why do you think your srs surgeon had you sign so many waivers?

I'm making this point because it's irresponsible to say that it is a perfect procedure and any problems can be controlled by following the aftercare regimen appropriately. There are undoubtedly people reading your words who even if they don't participate here will consider you an authority on this subject because of the decisive way your words are written.

I'm making this point because I wonder if your other expressed views about srs and what a transwoman is according to Kathryn aren't influenced by your (almost necessary it seems) belief that the procedure is perfect without fail by the surgeon.

Maybe it's fun to stir the pot though.

[Marleena]

I did not see Angela's questioning of the RLE process as a problem. I saw it as discussion and questioning instead. I'm sure she'll seek out a therapist's help when the time comes.

I think Kathryn just gets irritated reading the posts in this section and lashes out. I guess I expect to see people struggling because I am. I'm sure most of us will eventually deal with our own issues and get through this.

[Frances]

What I don't understand is all this theoritical talk about the RLE and it being a requirement. Protocols are for medical care providers, not patients. Almost everything is reversible except for FFS and SRS. People can start and stop hormones, but there is no coming back from SRS. Badtrannny notwithstanding, some people who had FFS could easily could back to living as males. I was not being snarky to Angela, I just may not see the RLE the same way.

(In my opinion, and in my experience) It means going full-time, full-time. Not just at home on the weekend or at support groups. It means using your female name at work and everywhere else. It means using your female voice, even with strangers on the phone, and correcting them if they think you are male. It means experiencing all that is good and bad about being in a woman in society. In islamic countries, it can mean having to wear a hijab when leaving the house, and to serve everyone inside the home. It is also a time to figure out if being clocked all the time is worth the pain of transition. If depression and anxiety are worse afterwards, then going forward may not be a good thing. It has nothing to do with wearing panty-hose or skirts (I never wear either), but it is about knowing what it means to be devalued because you look a little frumpy. In essence, RLE is actual social transition. And the process can end there. SRS does not help with social integration at all. It's a personal thing.

[Rianna Humble]

Enough of the name calling and inflammatory posts. This thread has run it's course.