HRT without therapy?

[Aubrey lee]

Hello all, so I met with a new therapist yesterday and was informed I no longer need therapy to start HRT. She said its as simple as a visit to the doctor for evaluation. Is this common practice? I live in a rather progressive state(VT) and was rather excited by this.

[LeaP]

It's been possible for years and getting more common. There are some for whom it is a perfectly reasonable path. I would strongly advise against it for most. Why?

1) In children and adolescents, cross gender manifestations resolve themselves most of the time.

2) In adults, cross-gender identification can manifest for reasons unrelated to transsexuality and which may not be evident to the individual.

3) In adults (in particular), transsexuality is associated with serious co-morbid conditions along with clinical levels of distress and dysfunction. The preferred approach is to sort these out first, when possible. (Mostly because of point #2.)

4) A proper evaluation for HRT should include readiness from both a psych and physical standpoint. The average (non-psychiatrist) physician is not trained to properly evaluate the first. Almost never, in fact. This applies especially to niche knowledge areas like gender.

Therapy per se isn't required so much as proper evaluation. While I'm not a fan of the variation of informed consent that basically allows (or pretends to allow) a patient to do what they want, a healthy, rational person CAN be evaluated fairly quickly in the absence of other issues, and lend SOME justification to the process.

A few considerations, though. You are talking about a huge life change. Is it wise to pursue such a thing without spending some time exploring it (and yourself)? How can you be sure it IS the right path? There is a steady trickle - few but regular - who go in convinced and come out the other side with regrets. I'll take it for granted that you are sane, but it's not much to pull off to fool a doctor for a few minutes, no matter how much of a loon someone might be.

[I Am Paula]

Alot, but not all doctors work on informed consent. The standards of care no longer demand therapy. An endo with trans experience is more likely to prescribe than a GP.
I suggest going into an appointment knowing a lot about hrt, specially side effects, and precautions. Just remember, the informed in informed consent is the important word.

[celeste26]

It is in the hands of the endo. Some will not allow you to start without that letter. Unless you can find an endo willing without a letter. The state really has little to do with it. WPATH does not require any particular length of therapy. It really would be rather unusual to do this without some therapy though. Frankly someone living for any length of time with GID would really be better off with it, even if you might not think so.

[JohnH]

I did not have to have any counseling at all. I initially self medicated and then my new primary physician referred me to an endocrinologist. The endocrinologist asked me questions for half an hour before he gave me the prescriptions. The same endocrinologist also has my wife as a patient, and he also asked her questions about me. So he is satisfied the HRT is appropriate for me.

I have to say going on HRT has been one of the very best things I have done with my life. My wife much prefers me on HRT.

Johanna Anna

[PretzelGirl]

My general thought is that following WPath gives some important checkpoints. We can go all over the place when in our own heads, so a rubber stamp from a professional isn't a bad thing. But it is just that, a recommendation. We are all adults and we want to accept the risk, then we can. But with the possible implications to our health and life, precautionary measures are a good thing.

[LeaP]

I did not have to have any counseling at all. I initially self medicated and then ...

When patients present self-medicating, it's fairly routine to get them on prescribed hormones. It's better than the alternative. Presenting that situation as "not having to have any counseling at all" is disingenous.

[Barbara Ella]

I go to the Howard Brown Health Clinic, where they operate on the THInC principle (trahsgender hormones informed consent). No therapy is necessary as they recognize the underlying nature as a medical condition, and not mental. they do an interview with a therapist to ensure you are informed about what feminizing hormones are all about, and to ensure you have the ability to make such a decision. I do not need a therapist for my GD, or my TS nature. they are medical, and hormones are the treatment. However, for the societal impacts on my mental state, it is a completely different story.

Barbara

PS. Medicare totally covers doctor visits and bloodwork, and my supplemental totally covers all hormones as per the diagnosis of "Undetermined hormone deficiency."

[Aubrey lee]

Thanks for the replies and concern. I am not intending on bypassing therapy as I find it very valuable. But anything you can share about your experience with HRT will be helpful.

[LeaP]

My first advice is to start studying. Start with Wikipedia articles and expand into the medical literature as you can. I have spent the last two or three years doing this to the point where I have become something of an armchair expert. (Believe me, I know my limitations, too.) One of the things this has done is convince me how truly inadequate the "informed" part of informed consent is. And less you are extraordinarily fortunate, you are not going to be prescribed and monitored by somebody who understands everything that's going on in a trans context. Because of this, you really should be prepared to materially assist in directing your own care. You may find yourself educating your providers to do so.

My second advice – which will inevitably fall on deaf ears (!) – is not to get overly hung up on dosages. Everyone wants more and higher. More and higher doesn't necessarily get you better or faster results.

Third, get used to the constant sorting out of short-term versus long-term. Including the very long term. Your views and observations of what is going on will change again and again.

[I Am Paula]

LeaP- Wonderful advice. I'm blessed with having an Endo who specializes in, and loves, transgender people. Many will have to train a GP, or OBGYN.

[Marleena]

My therapist "cut me loose" once I started HRT but left the door open for more visits if I needed more help. The therapist is essential to determine if there are other mental health issues at play that may cloud a patients judgment. Usually you can't start HRT if there are issues. Luckily earlier visits with other therapists over the years showed antidepressants weren't working for me but I had never disclosed gender issues back then, it was like Aha! The endo is satisfied that HRT was the ticket for me anyways.

There seems to be a trend for less therapy if the answer for the patient and therapist is clear. Good luck with it Aubrey.:)

[Angela Campbell]

My therapist told me that I didn't need therapy, and told me to call him when I needed my letters for srs.

[Jenessa]

Many will have to train a GP, or OBGYN.

Thats an interesting thought that never really occurred to me. As trans women, are the services of an OB/GYN beneficial to us? The only thing I can think of is mammograms and my wife doesn't see her OB/GYN for them.

[Jorja]

Jenessa, a practicing OB/GYN will be adept at the care of female reproductive organs health and the management of obstetric complications, even through surgery. Most do not have any experience treating MtF Transsexuals especially in the smaller towns in America and through out the world. In some of the bigger cities, LA, San Francisco, Chicago, New York, there will be a few who do have the experience and do a great job. You should look for an Endocrinologists but again, in small towns they do not have the experience.

[LeaP]

For any who might not think the neo-vagina is "real," I suggest this article:

http://www.gendercare.com/library/italiano_paper1.html

More than one study has concluded that the neo-vagina is (becomes, really) identical to a natal woman's vagina. To the question about the value of an OG/GYN, that means many health care considerations are also the same.

[ellieparsons]

I was told the same thing by my therapist, but i still wanted to go the letter route to go to the endo i wanted to go with. She said that Planned Parenthood out here near Syracuse, NY now does HRT with Conformed Consent.

[LeaP]

Just to be clear, virtually ALL providers use informed consent forms for HRT. What is being discussed here is a model whereby the informed consent essentially substitutes for other processes and possibly treatments (e.g., therapy).

The normal model captures a certification that certain procedures and risks have been covered with a patient. It ensures that key things are disclosed and provides limited protection to providers. The "informed consent only" model (for lack of a better term) is more about patient freedom and is intended to also transfer more responsibility to patients. If I were unfortunate enough to be a lawyer, I would look at the latter model as a green field money-making opportunity. That is, suing the living daylights out of providers on the basis of patient incompetency to consent.

[Jorja]

HRT without therapy? Why does this bother me so much? Maybe because therapy has been part of the process for so many years. I just see the system opening up a giant loophole and many unhappy individuals crying because they didn't really want the results of HRT. I know, that is what the informed consent is for. Well, those who want the Gatekeepers gone are getting their way. Good Luck!

[LeaP]

I agree, Jorga, and we see enough train wrecks around here to illustrate the point.

[Vickie_CDTV]

Elle, my local Planned Parenthood offers HRT for TSs... and even advertises the service in the local mainstream newspapers! Makes me wonder how/why they are qualified to do that, but ok. I am about an hour from you, so it might be coming to your local office there.

[Jorja]

Vickie, if you have to go there is a ladies room right around the corner.:) What is a PP?

[noeleena]

Hi ,

very different for my self i never saw a theripst and would not any way . 3./4 of an hour to tell a psych what i was and was doing i did not need to be evaluated or any other detail so many go through .in fact i was signed out and told i dont need to come back ever, ..

nore an Endo he was told the same . being what i am and how i was born is enough to know and old enough as well you know i get the impression that because im different i should be treated as a kid who does not know them selfs well enough to make a decision on my own account , im 67 now and knew at age 10 what i was .

As i,v said before i dont ....need .... to prove to any one what the hell i am , this is my life not some other person who does not know a thing about me , nore ever will,

i did not jump through the hoops as some most do or have to , i skipped all that ,and had hormones when i needed them and had my surgerys when i needed them i did not have to wait,
and i could have had surgerys two days after i rang up the Monash surgery dept in Australia, again at my request , all i had to do was fly over ,

We are not all the same and should not be put in a box and have to comply to this, i dont know set up that every one is the same ,

Again I went to Phuket walked in the door 2 am , had a sleep and Sanguan saw me later that morning next day up top and started surgerys 5 of over the next 7 days, ,

yes you said some train wrecks yes i agree and for what ever reasons, i know some have allso gone back to trying to be what they were = male as it is they were never trans or like to be women .i allso know some who topped them selfs could not hack it, and some no doubt need help , im well aware of that ,

Some of us dont need to comply because our bodys are different , my case as your well aware of intersexed , yet i did not need to bring that up as it would have created more issues i did not need to have yet every detail was taken care of in a lovely manner .

So some times some of us do need that lea way to be treated differently , and according to how we are , and not have imposed on us a lot of detail that is not suited to us,

...noeleena...