Gatekeeper or well intentioned Professional?

[Emma Beth]

I had another appointment with my Therapist last Wed.

It was originally to be an hour session. But it went over by half an hour.

As I continually make progress in my transition, she sees a lot of my progress. When she came into the waiting room to get me, she did a double take when she saw me this time.

Any way, to my point.

During our talk, she told me what has been taking so long for me to get on Hormones.

She told me that she had had a chance to talk with the Doctor that had done my Evaluation and found out that she has had my complete evaluation finished a long time ago.

She has been holding on to it so she could make sure that I'm more comfortable with the changes that I'm going through.

I had a chance to think about this and realize that this isn't a matter of my own comfort. There is always going to be situations and moments as well as parts of myself that I will always be uncomfortable with.

That is just life.

I realize that this is more of a matter of need and not one of comfort.

Sure, I'm a lot more comfortable with who I am as a person. But, the longer this goes without the medical changes the more uncomfortable I get with my own body.

Now, I can see that she is trying to be thoughtful about my needs. But, I don't think she truly gets it.

I kind of wonder if she's being an unintentional Gatekeeper through her actions or if she is intentionally being a Gatekeeper.

I think in answer to this question I'm going to give benefit of the doubt and say she's the unintentional Gatekeeper.

[Jennifer-GWN]

Personally I'd give her a hug and say thanks. See far too many jumping before they are ready...deep down. I realize this is somewhat like voting on Olympic figure skating but better to be mentally there and your therapist comfortable then jump the gun as it's hard to get back into a plane when your parachute jumping.

[Badtranny]

Yeah, it just kinda sounds like she cares.

I can't express how difficult transition can be sometimes. It's ironic that the first part is the worst part, and that's the part you're never quite ready for.

[I Am Paula]

I would tell her where to go, then push her off her chair.

[tgirlamc]

Hi Emma Beth!!!...

It sounds more to me like she is well intentioned and genuinely concerned with doing her part in your journey well for you. Far from the gate keeper mentality of many therapists not all that long ago... Since your post seems to encapsulate a concern of yours though, I would make it a subject to discuss at your next session!!!

Onward we go!!!

Ashley :)

[Badtranny]

I would tell her where to go, then push her off her chair.

LOL

Don't forget to pull her hair, help her up off the floor and then push her down again.

[PaulaQ]

The therapists here work on an informed consent basis - you see 'em twice and you get a letter. The Trans Clinic at Parkland Hospital now doesn't even need letters to start HRT. You go in, you tell 'em you're trans, they talk to you, you get a scrip.

I went through about 6 months of therapy before I got my letter. I was so close to ending my life, and my therapist still hesitated. I finally brow beat her into it. I thought I was going to have to start over with a different therapist. Her hesitation put my life in jeapordy. A month after starting HRT, I didn't feel suicidal anymore. A month after that, I felt pretty normal. I'd never felt normal before!

The trouble with gate keepers is they don't really know who's ready and who isn't. Mine wanted to wait for stability before prescribing hormones. Ironically, the only thing that brought stability to me - hormones. The anti-depressants / anti-anxiety meds weren't cutting it.

And yes, she is being a gatekeeper, and I suspect it's quite intentional. And no, she probably doesn't get it.

[tgirlamc]

help her up off the floor and then push her down again.

aka. The Double Whammy... Time tested and effective! :)

[Emma Beth]

LOL! I'm laughing at the mental image of me getting into a cat fight with Dr. Patel (The Dr. that performed my evaluation). Thank you Ladies for that smile

Badtranny, your words have always rung loud and clear with me. You may feel that you can't express that, but I think you do all the time. As a matter of fact, a lot of what you say weighs on my mind when I consider and think about what step is next for me. You are one of a few that I actually look forward to hearing from on a lot of subjects. Simply because you don't sugar coat anything, and you don't hold back. Sometimes when I'm reading some of the threads I wonder what you might say when you don't respond to a thread.

I'm planning on giving Dr. Frothingham (My Therapist) a call to tell Dr. Patel that she can turn in the detailed evaluation for Endocrinology to schedule my first visit for HRT, tomorrow.

I think that when and if Dr. Patel gets the trans veterans group started at the VA, she may finally "get it".

I'm grateful that Dr. Patel is concerned, but I feel that her concerns may be a little misplaced.

I think I will get my point across when I tell Dr. Frothingham that I was repulsed for the first time by what my body did this morning. She does know that I'm beginning to get grossed out by my body hair and how fast it grows back.

[arbon]

If you feel ready for hrt then I don't understand the withholding.
You need to lead the way for what is right for you.

[Emma Beth]

Arbon, that's what I have been doing.

I'm currently going through the VA to get things started. And going through the VA means jumping through extra hoops.

She thinks that she is helping by withholding. I understand her intentions. However, I don't think she realizes that her intentions could potentially cause more harm than good.

The big problem was that she wasn't speaking up about what she was doing right away, and it took about four and a half months from the day of the evaluation for me to finally find out what was going on. The entire time I have been getting confused and frustrated with how long it was taking for the ball to get rolling.

[arbon]

I don't think that is right of her

[KymberlyOct]

LOL

Don't forget to pull her hair, help her up off the floor and then push her down again.

You are always the diplomat :)

I agree with Emma Beth, I always look forward to Melissa's take, just trying to be a smart ass.

[becky77]

I'm all for gatekeepers to a degree as so many are confused and you see a lot of people wanting hormones for the wrong reasons.
In other areas of this forum there are probably quite a few that would take hormones for 'breasts and hips' without any idea of the true consequences, so you really need gatekeepers to save people from themselves.

That said when you know in yourself that you are ready it's then wrong to be held back. When I was ready I was only thinking of the mental reasons for taking hormones and a CIS DR is not going to understand that perspective.
We have the NHS here which is a long process and I was going crazy so I went private, it was the right decision for me not sure how bad a place I would have been in should I have waited a great deal longer.

So for TS people that have already done the internal work Gatekeepers can be a real issue especially if they don't recognise the needs.
For everyone else Gatekeepers are a necessity.

[Starling]

I think if you've spent your life--no matter how old you are--coping with the pain of GD without understanding it, then doing the intense self-questioning it takes to get a grip on just who you really are, and finally working up the courage to tell a total stranger your deepest, scariest secret; then you deserve to use the express line.

:) Lallie

PS: I wish I could grow hair like Misty's leg pic--on my head.

[pamela7]

i'm ready, zero doubts, green-for-go, probably got about 3 years wait, un-im-pressed.

[Megan G]

So for TS people that have already done the internal work Gatekeepers can be a real issue especially if they don't recognise the needs.
For everyone else Gatekeepers are a necessity.

I would have to agree 110% with this, how many times have we seen cd'ers post that they would love hrt just so they can get boobs/butts..

[becky77]

Makes you wonder what the consquences would be without Gatekeepers? Would word soon spread that magic pills were freely available, just how informed is informed consent?

[Eryn]

If your therapist isn't meeting your needs you should discuss the issue with her. If you can't come to a good resolution then it is time to switch therapists. My therapist discussed medical interventions with me, but it was up to me to ask her for referrals when I wanted them. She didn't push them. Once I had come to the conclusion that HRT was right for me she gave me a referral right away.

[Megan G]

Initially I did go to a doctor that works on informed consent but you needed to be referred to him. I was referred to him after spending years with my therapist working thru my issues/feelings.

The informed portion that I experienced was just a couple questions on history of your GD , what to expect from HRT and then spent a bit of time on side effects. I think for anyone that has spent time with a therapist that this is a good practice as they have proven that they understand what can happen and are ready for it.

[Lauri K]

Sounds like the gatekeeper needs to find the key to the gate in a shorter timeframe, I would be frustrated too.

I have always heard a lot of concerns or dislikes about using the informed consent model, but actually I think informed consent is still much safer than going to the under ground market. I believe if there are too many gates put in place it encourages going underground, also access to gender therapist and even PCP's who have experience is in limited supply even in larger cities. So many challenges and it seems everyone is reporting that thier therapist and physician has their own ways of doing things despite the guidelines........which reminds me of the popular phrase " no two transitions are the same "

[PretzelGirl]

I think that some level of gatekeeping will be a reality. As insurances pick up our needs more and more, the standard will likely be an evaluation before they will fund medical procedures. The insurance companies will demand it to control costs.

[Zooey]

Informed consent is much safer a better choice than DIY, and it's better than the "old school gatekeeping", but I do think that a certain amount of gatekeeping is a good thing. I've seen cases where the lack of it has led to some pretty questionable situations.

What absolutely needs to change though are the FINANCIAL gates. I believe everybody should have access to appropriate mental and medical healthcare, and given the support of their care team, legal gender changes. HRT is serious business, surgery is even more serious business, and transition is mega-business. Some gates along the way are a good thing, but when it's appropriate for somebody to transition, financial wherewithal should not be a limiting factor.

[Barbara Dugan]

My local LGTBQ clinic use Informed Consent but even them use a moderate gatekeeping, I have known a few indiduals that have been required to have pysocological evaluation before HRT, I personally used their gender teraphy clinic for a few months before making the final decision about HRT .

[Heidi Stevens]

The therapist could have just been testing your desire to take that next step, Emma. Wanting you to ask about the HRT may have given her a clue on how willing you were to take some action. My guess is enough time passed that she finally felt she had to bring the subject up. Kind of a little disappointing, but you seem to have handled it well and it's time to move on. Keep asking the therapist, and the endo for that matter, where things are going on their side of the therapy. It might help to keep things moving at your pace.

[Kaitlyn Michele]

remember you are talking about weeks and months and the scope of what you are doing is forever.

if your therapist held you back too much its worth evaluating a new therapist but its also worth directly and specifically working this out with them... if in the end you are unsatisfied you are are forced to move on..

and you have every reason and every right to question her every step of the way

hopefully going forward you are on a great track for you

[Mirya]

Since I live in the Chicago area, it was pretty easy for me to just go to an informed consent LGBT-friendly clinic and start hormones right away. I think I would have been pretty frustrated if I had to see a therapist to get approval.

I started seeing a gender therapist shortly after starting HRT through informed consent, not because I had to, but because I wanted to. I felt it would be good to have an experienced therapist on my side to guide me as another source of support in addition to my friends and family.

[jentay1367]

I actually had what I would consider an "green light" type of therapist. She wanted to hear certain platitudes from you. If she felt you fit the mold based on these things, she would acquiesce and give you what you want...... [I.E.] the letter many endocrinologists require to administer HRT. I freely admit I went in looking for that kind of relationship. But I have to add that it was made clear through Internet innuendo, that she was this type of person. So in a sense, she was "informed consent", but not until I had paid my 400.00 admittance fee and made all the stereotypical statements that fit her idea of a Transsexual persona. I'm a very introspective person and older so I'm not quite sure what years of therapy may have accomplished, but I do know that I found it unsettling that a very young, impressionable person could walk in and if by saying the proper things, may get more than they wished for. This of course is not necessarily true as I don't have first hand knowledge of how she would handle a younger patient. So I certainly don't want to condemn her, but apocryphal information I garnered led me to believe that she would. In other words, I felt she was a money making machine using the Trans community and peoples personal torture to accomplish those means.
Although I'm a big advocate for free will, I do understand that some folks need more guidance than others. In instances like these, that guidance is critical. I think you can invest so much energy into something, that in the end, you refuse to give it up..... even if it isn't right simply because of the "equity" you have involved in your process. All that being said, I do respect Therapist that want you to be sure, but at what point are they interfering with your rights to exercise your free will? It's always going to be a point of contention and opinion. Lisa

[Beth-Lock]

Transition is rather risky. At several points one may be at risk of suicide, it seems, on talking to several others. I am not trying to minimize what you are going through, just saying. Some have the scars to prove it.

In general, a new set of issues is emerging for the whole trans community, in that new methods and easier access to risky methods previously more restricted or withheld completely, are being tried now, and this experimentation using the trans community as guinea pigs,is especially noticeable and admitted by the Doctor's, in child-trans cases. The procedures manuals on what works and what doesn't, are now in the process of being written as experience with these new approaches, comes back in, to front-line Doctors..Nobody knows which changes in procedures will work and which ones will not yet. This will only start to be obvious in the decade to come.
I have seen a lot of new fads come and go, sometimes leaving a trail of human wreckage in their wake. I have simply been around too long, and was wide awake and observing thing, when they took place, while others seem to have missed the whole thing in many of these cases. So, some people cannot be said to have forgotten, but were just not aware of what was going on, for example, during the by student activists, and so on. . So, it is not hard to understand, that even those who lived through failed experiments have learned nothing from the opportunity to witness them -- they were simply busy doing other things than paying attention.

So, I don't expect that a majority will avoid the chronocentric fallacies so prevalent in our times, in the trans case either. Still, in our personal live as trans, we might realize we always have a need to be careful in our own cases, and those of our friends -- and the popularity of any fad is not necessarily an excuse for believing everything one hears..

[tgirlamc]

My experience was straightforward informed consent... Having no real knowledge of the process going in I was actually a bit suprised how easily the letters and hormones were offered ... It worked for me but I can definitely picture it going very badly for others... I think a degree of gate keeping is probably a very good thing and can save lives but too much is a bad thing as well and could cost lives... It's a delicate balance in the hands of a wide range of fallible human beings... Results both good and bad will come out of it...

Take Care,

Ashley :)

[Starling]

What bothered me about the informed consent clinic I went to was feeling I was on my own, and I needed to be able to trust more in the level of care I was getting. I had to break off after a couple months for medical reasons, but even before that I was beginning to fear that they had not been thorough enough in their physical evaluation.

As it happens, I may not be a candidate for HRT, anyway--not because of my gender identity, but my dicey physical health. So while I believe our own feelings of GD should be given great weight in gender therapy, due caution is required on the medical aspect of transition.

:) Lallie