Bit of a shock

[PennyNZ]

I have read this forum for several months and had a reasonable idea what to expect re HRT

Had my first talk with a theropist on Monday night after being referred by my doctor a few weeks ago.
I felt that all was going well, was open and honest and we were mirroring our siting positions so felt comfortable.
She is really nice.

I was telling her of my plans and proposed schedule, but she interrupted me saying, "do you know what the proceedures here in this area (of NZ) are?"
"No, not reallly I said"

"Well, before you can start HRT, the Endocrinologist requires you to live for one year as a woman"

Oh, how naive I have been. I had read that happens in some places, but did not think it was required in NZ.
I can understand the commitment requirements of the Endocrinologist

And here's me thinking that I could gently start my transition, coming out in about a year or so.

Well I guess it is different schedule for me now. I am going to do this !!!


Penny

[Kaitlyn Michele]

Good luck to you Penny

Remember in all things medical you are your own best advocate. Get to know those rules.. as you go forward you are not going to want surprises to derail your progress!!

For example, who is going to "decide" on what living as a woman means? Do you dress frequently? Make sure you get very specific feedback from the specific person that is going to sign off and if you work with them and you are serious you never know if that timetable can get moved for you or accomodations can be made for you specific circumstances

[I Am Paula]

My only thought. REALLY? That seems so archaic, to force you to live, right off the bat, as a woman. It's outdated ideas like that, that cause people to self med, and other dangerous practices. Sorry, I'm speechless.

[DebbieL]

You should find out if this includes work. Many states in the United States require that you live as a woman for a year, but therapists will often let you do "120 mode", essentially, everything EXCEPT work and commute time.
Once you start hormones, you don't have much time before you will have no choice but to live 100% female.
Your therapist will also want to know that you have a plan for a stable work situation, for example, an employer who has a strong diversity program that supports and includes LGBT people. Even then, your employer may decide to reassign you to a different location or department, so that you can have the experience of people who DON'T already know you accepting you as female from the start.

Your therapist will also be looking for other signs of commitment, like have you done laser or electrolysis, are you managing your weight, are you beginning to move and gesture like a girl, and other subtle things that are hard to fake.

If you are living 120 hours / week as female, it will become obvious to coworkers and management that you are transgender, you will just have to tell them when you plan to transition.

[Dianne S]

Penny,

Find another therapist. According to the NZ Ministry of Health at http://www.health.govt.nz/our-work/hospitals-and-specialist-care/high-cost-treatment-pool/gender-reassignment-surgery the prerequisites for HRT are:

Demonstrating knowledge of what hormones can and cannot do, as well as their risks and benefits.

Documented real-life experience of more than 3 months and/or counselling for at least 3 months.

See also the publication http://www.health.govt.nz/system/files/documents/publications/gender-reassignment-health-services-for-trans-people-in-nz-v3oct14.pdf which on page 18 says: "The WPATH Standards of Care recommends that a person has either lived in their appropriate gender (real-life experience) or undergone psychotherapy for a minimum of three months prior to starting cross-hormones. Either can help a trans personexplore the implications of transitioning. However, due to safety or other issues, there may be good reasons why a trans person may wish to commence hormone treatment before changing their gender role,and this is regarded as the typical treatment pathway in the HBSOC. It is useful for the health professional to check whether a trans person feels safe to present in their appropriate gender identity and what, if any, further support they require.

So yeah... educate your therapist or find another one.

[PennyNZ]

Thank you Kaitlyn, Paula, Debbie and Dianne for your replies.

Dianne I will follow up those resources you quoted with the therapist, thanks
Good advice to define " live like woman" Kaitlyn
Debbie, thanks - I am a part time contractor with a small progressive thinking business, whose owners are quite liberal, but one never knows I suppose. Not the end of the world if they strong negative reactions.
My other work is for my own clients, and I can expect some negative reactions from some I guess.

Thanks again
Penny

[Heidi Stevens]

By all means Mary, find out if the RLE is required in NZ. Arkansas allows the three month therapy rule and I was allowed to begin HRT last month. My personal plan is to not present as a woman full time for the time being, but the HRT therapy has helped me mentally tremendously. It does seem strange that after a few years of the current WPATH standards some places still demand RLE.

[Dianne S]

My other work is for my own clients, and I can expect some negative reactions from some I guess.

You may be surprised. I have had only positive responses from clients since coming out. If you're good at your job and you provide good value to your clients, they won't care what gender you are.

[stefan37]

You should find out if this includes work. Many states in the United States require that you live as a woman for a year, but therapists will often let you do "120 mode", essentially, everything EXCEPT work and commute time.

What are you talking about. I haven't heard that states require you to live a year as a woman before being prescribed hormones. You can easily hide hrt changes for well over a year before needing to go full time.

[Barbara Ella]

I know of no requirements of RLE for HRT acceptance, just surgeries, and even that is being relaxed. Educate your therapist as to the mental calming HRT provides by lessening your dysphoria. It makes planning and taking actions much more realistic since you are not rushing to get things done in an attempt to "find" yourself. You are right there, and the HRT helps you find yourself and see precisely what you need to do next.

Never had to see a therapist for my Dr. to put me on HRT. No need, it is a medical condition, and only a first step in any transition.

Barbara

[PennyNZ]

You may be surprised. I have had only positive responses from clients since coming out. If you're good at your job and you provide good value to your clients, they won't care what gender you are.

That is great news for you. I hope it is the same for me. Some of them go back to the mid 1990's



So yeah... educate your therapist or find another one.

I don't think it is the Therapist Dianne - sounds more like the Endocrinologist, but will find out more next meeting in 10 days or so

Thanks again
Penny

[PretzelGirl]

What are you talking about. I haven't heard that states require you to live a year as a woman before being prescribed hormones. You can easily hide hrt changes for well over a year before needing to go full time.

I was thinking the same. Now I understand the WPATH standards used to require that. But we used to start cars with a crank on the front too. Long gone and glad for it!

[HelenR2]

Also bear in mind they might want PROOF of RLE.

[Kimberley]

It is safe to assume the doctor does not ascribe to the WPATH Standards of Care? The standard in the latest Version 7 is informed consent. That is what is being used here in my part of the world. RLE can come before during or after and is not a prerequisite to any healthcare under the standards. This sounds more than archaic; a step backward 20 years.

Very strange in this day and age in a modern country. For me personally it stirs horrible memories.

I am so sorry you have to go through that.

[Dianne S]

sounds more like the Endocrinologist

OK. I find it a bit odd that an endocrinologist would be willing to prescribe cross-hormones, but doesn't know the latest transgender standards of care. There's a bit of a disconnect there.

Perhaps your therapist could have a word with the endocrinologist? Or find another one?

[JohnH]

I don't understand why a genetic male would have to live as a woman for a year before HRT either. I have been on M2F HRT for over three years and I still live as a man for the most part, except for my long hair, and lipstick and eye makeup for church and business. I have D cup breasts but I have retained my masculine name and gender designation. I have made no effort to raise my deep bass speaking voice nor do I intend to do so.

If someone sees me it is readily apparent the effects of the M2F HRT. I make no effort at all to hide the effects.

I did not have to see a therapist to get the medication from an endocrinologist. But the effects of calming me and making myself feel better about my body are priceless.

John

[karenpayneoregon]

Hear in Oregon I was permitted to start HRT by consulting with a doctor which I did then months later started my 12 month live as a female. Seems every state has their own twist on HRT.

[PennyNZ]

Wow Karen - that is great and is how I wish to progress my transition.

[Eryn]

It's amazing how standards vary by location and how many are apparently made up on the spot by the professionals involved.

For HRT, I needed a letter to the endo from a therapist stating that I had received counseling. That's it. My personal criteria was much greater than that.

[Michelle789]

In California, you don't even need a letter from your therapist to start hormones. Unless you're getting covered by insurance, then the insurance company may require a letter to cover you.

My own personal criteria is that I was certain enough that I am trans and going to transition before starting hormones. I was living "165" for almost two months before starting hormones. I was laid off from my job and lived as a woman entirely except for my once every other week AA meeting. I ended up starting hormones, getting rehired as a woman, and came out at AA and went full-time by last August.

I guess many places still require the archaic living full-time as a woman to get hormones. I don't like that because it forces you to come out, risk losing your job, friends, family, and everything, just to get hormones. Sometimes we require the confirmation of our gender identity from hormones before we have the confidence to come out to people and take those risks. My own personal belief is you should only come out to people when you know you are definitely going to transition. This move is irreversible, and is the only other irreversible move aside from surgeries.

[JohnH]

Michelle,

I agree with you. It would be mighty hard to pass as a woman having the body hairiness and scent of a male in addition to being flat chested.

Suppose an individual comes out as a woman and lives as such for a period of time as a condition to starting HRT. He starts HRT, and hates the effects of HRT and realizes transition is not for him. Now this poor individual is placed in a very awkward position of explaining to his relatives and acquaintances he is not going to transition and the reason.

Now in my case it would be quite easy to pass as a genetic woman - all I would have to do is to learn to speak with a treble voice. But I have decided that "it's not going to happen" (to use a phrase from Rick Harrison of Pawn Stars :)) as I am content the way I am.

John

[Kris Avery]

Johanna,
I will 2nd that statement. The voice "ain't gonna happen", of course, neither will the face or hairline.
Does it count if I am female looking from the chin down? :o

[Eryn]

In California, you don't even need a letter from your therapist to start hormones. Unless you're getting covered by insurance, then the insurance company may require a letter to cover you...

In my case it was an insurance requirement. The therapist is also covered, except for co-pays, so the requirement isn't onerous.

[JohnH]

Johanna,
I will 2nd that statement. The voice "ain't gonna happen", of course, neither will the face or hairline.
Does it count if I am female looking from the chin down? :o"

I don't have a brow ridge nor do I have any beard shadow. I frequently get ma'amed and when I reply in my deep bass voice, the person says,"Oh sorry, Sir". What really irks me is how society regards being masculine as being superior to being feminine. It's OK for a woman to dress as a man but it is regarded as perverted for a man to dress as a woman. What a damnable double standard!

On a side note one time I got ma'amed over the phone. That was a mystery to me since the pitch of my speaking voice is toward the bottom of the male range (typically 90 Hz but sometimes as low as 65 Hz where a typical man is at 120 Hz). I guess there were other clues since I speak with a wide range of pitch and speak expressively.

John

[Michelle789]

Suppose an individual comes out as a woman and lives as such for a period of time as a condition to starting HRT. He starts HRT, and hates the effects of HRT and realizes transition is not for him. Now this poor individual is placed in a very awkward position of explaining to his relatives and acquaintances he is not going to transition and the reason.

This is exactly why the live full-time as a woman for a year requirement to get HRT is ridiculous. If you take hormones for a few weeks and don't like it, you can stop. You won't get any irreversible changes.

Once you come out, there's no going back.

[jennytvx]

i live in california and we have something called informed consent. google it. many clinics and some doctors will provide this. it's when you know what you want and read the disclaimers and they will put you on hormones. the clinic or doctor will continue to monitor you and prescribe the HRT for transition. it took me two weeks to get my first script. my insurance company covered the meds, no questions asked because california requires health providers to treat transgender patients. try reading up on informed consent, i'm sure there are clinics or doctors that know this method in your area.

[Rianna Humble]

I get fed up of people offering Informed Consent as an alternative to Standards of Care. In any decent standards of care (such as the WPATH model), the patient has to take an active part in their healthcare. They are told what the options are and agree to a specific course. This is true informed consent.

We have come a long way from the opening post which was about what one particular endo in New Zealand apparently wants before subscribing. Wouldn't it be an idea to get back on track?

[Michelle789]

Informed consent is the rule in California. However, individual insurance companies, although required to cover transgender treatments, may still create obstacles and have their own requirements. Some insurance companies may require an HRT letter from a therapist in order to cover hormones. Without the letter, you could still get hormones, but would have to pay out of pocket.

I have another transwoman friend whose insurance company pays for all her transition costs (100% coverage, no co-pays), but requires you to be on hormones for a year before they will pay for electrolysis. She could still get electrolysis, but she'd have to pay out of pocket, and doesn't have enough money for that.

Some insurance companies still require you to get letter from a doctor saying the surgery or procedure is "medically necessary."

So if you pay out of pocket, you can essentially do whatever you want if you live in California. If you want your insurance company to pay for your transition costs, you have to follow their rules, which may be WPATH, or even stricter in some cases, or maybe not as strict but they still have rules you have to follow.

IMO I am for decent guidelines and standards. But some are unrealistic. Requiring you to live full-time for a year to get HRT, or requiring you to be on HRT for a year to get electrolysis paid for, is going too far. In fact, I'd recommend completing all or most of your beard removal before going on HRT. But Kaiser Permanente won't cover you if you do that.

[JohnH]

In fact, I'd recommend completing all or most of your beard removal before going on HRT. But Kaiser Permanente won't cover you if you do that.

In my opinion that would depend how conspicuous and dense your whiskers are. In my case I do not have a beard shadow at all, and my facial skin is flexible as the whiskers do not seem to stiffen my skin. My whiskers are barely noticeable up close in the morning before I shave. Sure it's a nuisance to have to shave in the morning, but so is permanent hair removal. Now on the other hand, there are individuals who have a pronounced beard shadow even right after shaving. Those M2F individuals definitely need permanent hair removal.

John

[cheryl reeves]

my 2 cents on this,is i have to agree you need to live full time as a wonan before you start any hrt or srs,this to me insures the individual truely wants to transition..sure you have to be out in the open to everyone,so if your going to transition why continue to hide,sure you might lose everything,but your going to lose everything anyway..it drives me up the wall when someone says they are going to transition while still hiding in the closet. i burned down my closet and everyone who knows me knows im tg but not going to transition.

[CONSUELO]

I remember a grad student colleague of mine at CAL who wanted to transition and was required to live as a woman for a year before surgery. That was in the 1970's. We were all told about it and Diane showed up and took part in normal student life. She didn't seem to mind and we all got along with it.

[JohnH]

my 2 cents on this,is i have to agree you need to live full time as a wonan before you start any hrt or srs,this to me insures the individual truely wants to transition

SRS - yes, I agree with you that you need to live full time as a woman before having that irreversible operation done. Personally I do not even like the thought of SRS done on me - I'm content with my boy bits.

However, I vehemently disagree with you that you have to live full time as a woman before starting HRT. Even at my stage of being on HRT for over 3 years I could have a double mastectomy [perish the thought!] to undo my breast development. I have made it clear I have not hidden the effects of M2F HRT even though I still have my masculine name "John" given by birth and have retained my male gender designation. If a genetic male is going on M2F HRT he needs to own up to the effects of the medication as I have. If he is not willing to show the effects of HRT he should not be on the medication.

John

[cheryl reeves]

why start hrt if your not going to go full time? i never could figure that one out....

[PretzelGirl]

Cheryl, I don't believe most people won't put HRT and full-time together. But if you do the HRT first, you can reach a point where the comfort with oneself while going full-time may be better. So we take HRT, first off to feel right and real. But in relation to full-time, we want to have it help our natural feelings and appearance before going full-time instead of going full-time first, then waiting to take HRT, then waiting for the effects.

[cheryl reeves]

in other words putting the cart before the horse which gets one nowhere..almost like hiding in the closet til the coast is clear..or many many other excuses..ive heard em all and heard em again..if your going to do something do it and not beat around the bush about it. yrs ago my wife told me i didn't have the guts to tell my family,i went and told my family myself..everything i do,i do and i don't beat around the bush hem hawing..it was my wifes fault she didn't pay attention the first two times i told her,i took the third time for it to sink in that it wasn't going away..like i said im weird i chose to face my problems head on and move on and not dwell on it,for i burnt that bridge so that way there is no turning back..

[PennyNZ]

Cheryl, I don't believe most people won't put HRT and full-time together. But if you do the HRT first, you can reach a point where the comfort with oneself while going full-time may be better. So we take HRT, first off to feel right and real. But in relation to full-time, we want to have it help our natural feelings and appearance before going full-time instead of going full-time first, then waiting to take HRT, then waiting for the effects.

I agree with you Sue.

When I go full time, I want to look more than a woman than I do now.
I am going to have FFS done (that is a major commitment in itself), and I would like to start HRT prior to that. I really want my face to look as womanly as reasonbly achieveable, even if my body is not to that standard.

Other surgery can be done later if I choose (especially the bottom bit - as I dont know yet if I want to go there).

Pen

[Michelle789]

Sue, I believe everyone is different. I believe that people should be allowed to start HRT before going full-time, or to go full-time before starting HRT. Everyone's needs are different, just as every transition is different. I was seriously miserable dressing as a man that I had to go full-time (well, 97%) before starting HRT. Ok, and partially my life circumstances made it possible for me to go 97% full-time or "165" before starting HRT.

[Dianne S]

Cheryl, everybody is different. I don't think it's up to us to criticize the order in which people do the steps in transition. I think health care professionals should show maximum flexibility.

The only exception is that I agree with one year full-time before SRS because SRS is such a major and drastic step.

[stefan37]

Which is why the standards of care have changed and suggest hrt before full time. Many will find relief and have no need to go farther. I can fully understand living in the closet until you feel comfortable enough mentally and your presentation to live as female. Others have employment issues they need to deal with. It's very difficult to transition with no money. Even if you are lucky enough to have insurance cover some of all of it.
I know the discomfort one feels while starting full-time. I was hormones over a year before I went full-time. Hrt helped my mental state immensely. I elimination of anxiety allowed me to focus on my transition and not fight with myself. Physical changes have been lackluster and living full-time with my facial structure was very uncomfortable. Although I had confidence to be who I am. I was constantly gendered male. It wasn't until I had facial reconstruction that I experienced a comfort level that exist before. Getting gendered as female became the norm rather than the exception.

Some of us transition and jump off the cliff (many blindly) with no going back. Others jump on the train and travel as far as they need to feel comfortable and mitigate their GD. Then step of at the station they feel comfortable.

Had I gone full-time without the benefit of hormones probably would have been doable. But would have been much more difficult without the emotional relief offered from them.

Requiring somebody to go full-time and live a period of time without that benefit is cruel and would cause great distress.

[Rianna Humble]

why start hrt if your not going to go full time? i never could figure that one out....

There is a school of thought that favours the use of low dose hormones as a diagnostic aid with less clear-cut cases of Gender Dysphoria. The thinking appears to be that someone who is not Transsexual will react unfavourably to the cross-sex hormones whereas someone who is transsexual will thrive.

[Cheryl123]

Hi Mary,

I think it's best if you do a little research on your own. This is a link to a NZ gov't publication put out in 2011. http://www.moh.govt.nz/notebook/nbbooks.nsf/0/255adb3e32bc40eacc2578f5000af05b/$FILE/gender-reassignment-health-services-for-trans-people-nz.pdf

It recommends that Health Professionals follow WPATH standards and states explicitly that an RLE of 3 months OR 3 months of therapy should precede HRT. The publication recognizes that it's not always safe for a trans woman to present in public and that other issues such as getting fired from your job make RLE difficult.

I think getting a second opinion is best here. Good luck.

Cheryl

[cheryl reeves]

i wasnt critizing aanything or anyone. to me the moment you start on the path of transition,you should be able to go full time. to me its a excuse to fall back to your male side when times get rough,this is the same with closeted cders. when i came out nothing changed,i wear gender neutral clothing between dressing times. like i said this is only my opinion.

[Dianne S]

to me the moment you start on the path of transition,you should be able to go full time.

I tend not to tell people what they should do. Each person must decide for him or her self. For lots of people, it would be impractical or even downright dangerous to go full-time the instant they decide to transition.

[stefan37]

i wasnt critizing aanything or anyone. to me the moment you start on the path of transition,you should be able to go full time. to me its a excuse to fall back to your male side when times get rough,this is the same with closeted cders. when i came out nothing changed,i wear gender neutral clothing between dressing times. like i said this is only my opinion.

That's total bull hockey. There is so much preliminary legwork before one can go "full time". You need at least 1.5-2 years facial hair removal before you are cleared enough of facial hair. Going full-time before that can be very embarrassing with facial hair that the tech can remove. You are not transitioning, you should temper your comments until such time that you do and realize exactly what it entails. You disclosed you are TG and present in various ways, but I'll bet you identify primarily as male. And go farther and day most that interact with you gender you male as well.

[Angela Campbell]

Wearing gender neutral clothes "between dressing times"

Really? That isn't transition or full time.

Yes it is possible to immediately go full time, but that would be a very difficult way to go. Planning, preparing and getting your ducks in a row is much better but still very difficult.

Bad advice. Go full time first and then let us know how it went.

[Marleena]

Post #39 by Stefan pretty much nails it.:)

I have no money, live in a transphobic city and my wife's medical partially covers HRT and nothing else. Luckily HRT will probably let me live my life out since I'm a late transitioner too. Nobody in their right mind would walk the streets here unless they could pass well. I need FFS , trach shave, etc. So what does that make me since I can't pay for all of it?

The trend is now to get trans people the medical care they need quickly. Some trans people skip therapists, self medicate, then go on to SRS with no regrets, so there you have it.

[Michelle789]

to me the moment you start on the path of transition,you should be able to go full time. to me its a excuse to fall back to your male side when times get rough,this is the same with closeted cders.

Everyone's transition is different. Some of us need to try hormones to help us figure out if we're female identified. Some of us choose to go on HRT for a year and do electrolysis before going full-time. Others (like me) go full-time before starting hormones. Oh, and sometimes we have reasons we need to go back and forth. Maybe we start hormones, and start presenting on nights and weekends, but we're not out at work yet. Maybe we're not emotionally ready to come out at work. Maybe we want to work with HR for a few months before coming out. Maybe we want to save up a few extra $$$ before coming out. Maybe there's another situation which we're not ready to come out yet. Some of us may consider relocation before we go full-time, or switch to a more trans-friendly job, but in the mean time we can still start living part of our lives as women.

CDers have no intent of transitioning, and have every right to dress as men since they identify as men who occasionally like to dress as women (or wear one or two articles of clothing). A male identified CDer who dresses full-time as a woman is lying to themselves and to the world just as much as if they never CD, or as we do when we dress as men.

[JohnH]

As I wrote before I am retaining my masculine name John and my male gender designation. However, I do not have any male mode or female mode so in a sense I am not closeted. I don't wear wigs since my hair is quite long enough. And I have no use for breast forms or hip pads since I have natural breasts that I do not hide at all. I also wear lipstick and eye makeup as mentioned before for business and church. And my overall appearance is feminine. So in a sense I have already transitioned.

I really feel quite uncomfortable wearing a coat and tie men's outfit. The last time I wore such an abomination of an outfit was over a year ago for my wife's friend's wedding. I stay away from plaid shirts for business and church since they look too masculine on me, something my wife agrees with. I do respect my wife's feelings by not wearing dresses publicly except for Halloween.

The process has been gradual instead of sudden.

John

[Kate T]

OK back to the OP:

According to the following document:

https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0CEYQFjAH&url=http%3A%2F%2Fwww.health.govt.nz%2Fsystem%2Ffil es%2Fdocuments%2Fpublications%2Fgender-reassignment-health-services-for-trans-people-in-nz-v3oct14.docx&ei=yHBVVdLALIXj8AXL-4HYAQ&usg=AFQjCNGedu72Je1uw0snxCmqJAAcfWw8sg&sig2=b5GmC0zjlDb4vdcaUUQY6A&bvm=bv.93564037,d.dGc

(search endocrinologist new zealand transgender and you should find the link on the first search page results)

the NZ health boards only require compliance with WPATH guidelines. As has already been pointed out, the old 12 month and even any sort of full time RLE has been dropped from the WPATH guidelines at least for the prescribing of HRT. There would be very few Endocrinologists in Aus and NZ that would require RLE prior to starting HRT. They MAY feel on consultation and recommend you seek guidance from a therapist or psychiatrist before starting HRT.

See if you can find a local support group. You will probably have to travel to Aukland, Christchurch or perhaps Wellington to find one but it is possibly worthwhile to gain from other peoples experience.