New Version of Standards of Care

[Nicole Erin]

Problem with therapists is if they had their way, every last human would be in therapy. Of course their main target are parents of younger kids. Each time a kid screws up in school, they scream "autism". To therapists, it is merely a game.

So basically with TS women like us, many of us don't pass well enough to really settle into a decent life, which partially means working for next to nothing. Well, except the younger prettier ones who can escort. So we are broke and then some SoC is saying we need to pay a fortune for fancy doctors. Or if you wait too long, like beyond age 18, your transition may not be as successful. But what kid has $1,000's to spend on doing it the SoC way? With the older ones who might have the money, what happens when their entire life crashes cause all the sudden they are trying to live as a woman, par the RLE?

The only ones the SoC filters out are the ones who are broke. So those of us who are broke basically have to do the best we can with what we have.

I live full time in my new role, well, more "exist" full time (being single and broke is not "living" for any gender) but the point is, I didn't need to talk to some "therapist" about this.

And with filtering the true loons, alright, do they REALLY think there are droves of lunatics out there who have the money to go get SRS on a whim?

The medical field has a habit of sending people to doctor after doctor, milking the patients' funds, all in the name of "go see GP, go see specialist, go see another specialist...

[Melody Moore]

So basically with TS women like us, many of us don't pass well enough to really settle into a decent life, which partially means working for next to nothing. Well, except the younger prettier ones who can escort. So we are broke and then some SoC is saying we need to pay a fortune for fancy doctors. Or if you wait too long, like beyond age 18, your transition may not be as successful. But what kid has $1,000's to spend on doing it the SoC way? With the older ones who might have the money, what happens when their entire life crashes cause all the sudden they are trying to live as a woman, par the RLE?

Nicole I really urge you not to get strung along by the lies, propaganda and conspiracy theory another poster is trying to hatch
here. I personally like the new SoC and I don't see much wrong with them except the classification of gender issues falling under
the DSM is still a sore bone of contention that WPATH is also trying to overcome in this version but fell well short of achieving that.

Now for your allegations that gender transition is only for the rich - sorry but that statement is NOT true!

In many places transgender health services are subsidised and paid for under public health systems. The
new SoC has more inclusion of other gender variants to be included in transgender health services because
they also have health issues to deal with but that doesn't always equate into therapy and treatments for
gender transition. I think this SoC will weed out a few that make mistakes with gender transition and this
has to surely be a threat to those that don't fit the criteria for specific therapies and treatments. The only
legitimate gripe I have heard has been about the inclusion of gender identity disorders in the DSM, the rest
is just utter nonsense.

[Aprilrain]

Since when was anyone other than YOU obligated to pay for Your medical wants or needs? Is this thread about the usefulness of the SoC as a guideline for treating trans people or is it a political debate about private vs. public funded health care? regardless of the system you live with Doctors are going to want to get paid! they are going to want to be well compensated for the many years they spent in school to become SKILLED surgeons They are going to want to off set their considerable liability with greater compensation. This is how it works, someone is going to have to pay for it! As certain members here have pointed out even in Canada where health care is "free" $$$$$ were payed out of pocket to make transition happen. Since there is a political element to this debate hers my 2 cents, no system is perfect however the system with the greatest freedom of choice is going to be the one were the user pays directly. in a socialized system the patient is at the mercy of bureaucrats who's job it is to decide wether a service is "necessary" or not. transgendered health care represents a vanishingly small number of the population as a whole compared to say senior citizens who's health care needs are many and who's numbers grow larger everyday! who's going to get the axe when they are looking for a convenient place to save a few bucks??????
consider, who thinks BA should be considered a "necessary" treatment for a natal woman who just wants bigger boobs? what about a natal woman who just feels her face is too masculine? should FFS be considered a necessary procedure? Lets say "they" determine that SRS (or whatever you want to call it) is indeed medically necessary for a transwoman's long term mental health, but hair removal, BA and FFS are considered elective then to top it all off they TELL YOU which doctor is going to preform this surgery on YOU because he or she is the one who they are willing to pay! HHHHHMMMM? SRS with joe shmoe for free with questionable out comes or cough up the money for a surgeon with a world renown reputation??????

[Kaitlyn Michele]

great points april...

fyi the SOC is not about "weeding out the crazy people.." to me, that kind of talk gets ts people in trouble.. gender variance is a human condition..
it reduces you if you truly believe this, and comments like this are what set off other gender variant people..being transsexual doesnt create an extra right for you..
it's important to separate out people that will not be well served by transition, but it's not a value judgement, people that pursue transition while NOT TS are not "loons"... they need help to learn that transition will not suit them

i have met alot of ts people...our loon ratio is quite high vs the general population

the SOC is about creating a template that people can use to hopefully help..

feel free to parse it word for word...its a waste a time and energy...nobody looks at the SOC as a set of rules to be followed line by line..

[Christy_M]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

I can give a good reason to rush to SRS although I am in my RLE now. My wife divorced me, Her insurance covers GRS but now I am not covered unless I sign up for the Cobra at my cost (which I did). Since that Cobra covers 18 months and I need after care, I am rushing to get the GRS as soon as practical so that I don't incur incredible debt for something I am going to do anyway. While there are probably many reasons for rushing, knowing who we are and where we are going is the first real test. I agree that there may be some who aren't sure and should take a little time to reflect before the "snip/tuck" but for many, we already know who we are and don't need restrictions from someone else's opinion called the SoC. There is good check points in there for those that are unsure but I think IMHO that the burden of fulfilling the guidelines in the SoC restrict too many beyond reasonable and may even force their decisions to remain in the closet. Just sayin'

[Beth-Lock]

... I have seen a lot of people who wanted access to hormones and surgery NOW or they were going to give up on the whole thing! Most of them did. Transition is a waiting game, and if a person will stop the transition process because the wait is too much to bear, then they may not be trans after all. Finding that out after surgery can have dire consequences.

As someone else said the problem is when you are approaching the point where you are getting old, and your luck with your health is running out, you do have a sense of urgency, because you know it may be now or never. You are between a rock and a hard place.

Of course time is a great aid in finding out if you are truly ts to the point where GCS is indicated without a doubt. But, baring the development of better evaluation techniques that are faster, some of us do not have the luxury of taking the time to let this issue be sorted out. We need a decision now. It is a major dilemma and a Catch-22 isn't it?

Frances, I admire your posts and find them sensible. What bothers me is the lack of urgency some of the therapists, I admit, over booked, have when it comes to dealing with older TS like me. But then even if they had the time for intensive work with us, would their diagnostic and psychotherapy tools be adequate for doing the job of speeding things up? Probably not always.

[Aprilrain]

Of course time is a great aid in finding out if you are truly ts to the point where GCS is indicated without a doubt. But, baring the development of better evaluation techniques that are faster, some of us do not have the luxury of taking the time to let this issue be sorted out. We need a decision now. It is a major dilemma and a Catch-22 isn't it?

This indeed sounds like a real dilemma. I'm 35 and I feel a sense of urgency, one could be 20 and feel she has completely missed out on growing up as a girl. Every older person knows that young people don't have a clue how lucky they are LOL!

BUT heres the thing, it is not the job of a therapist to work out if you are TS or not!!! I don't feel that this can be emphasized enough. I you are going to a therapist with the expectation that you will be TOLD you are TS then watch out QUACK ALERT!!!
I would think any self preserving therapist would be very hesitant to suggest to a person who doesn't already know what they are that they are TS. I sought therapy cause this gender crap wouldn't leave me alone! I knew a lot before I ever went because I looked stuff up on the internet. I was already past the point of thinking there was a cure and I had a pretty good Idea of where I wanted to go but I guess I wanted to make sure I wasn't just crazy!

[Frances]

Money should not be a reason to speed up anything in my opinion. Ten months ago, an American had her surgery in Montreal and woke up to find out she did not feel like a woman, as she had expected. She went crazy and attacked the nurses and was put in a psychiatric clinic for suicide watch. She had went around the SoC and had bought her letters.

What are we talking about anyway, years or months? Where I live, one cannot change their gender marker without SRS, but it is not required to start living as a woman full-time, which is the real goal in my opinion. How long does hair removal take? I have been doing electrolysis and laser for over 5 years. Would you stop because it will take too long? Same thing with a college degree.

The hospital where I went for my transition is very strict about the SoC. They require a minimum of 2 years of weekly therapy with a 1-year RLE. They NEVER tell any patient/client that they are trans and NEVER recommend HRT or SRS, nor do they prevent the person from getting at these things. Their mission is helping the person explore their psyche and clean up shop (mentally). If the person still demands HRT or SRS after set periods of time they give it to them. Everyone that I know who gave up on transition or detransitioned, EVERYONE, thought the hospital's process was too long and arduous. Everyone that I know who went through this program to the end has transitioned and is well integrated into society.

What has age to do with it? Like Aprilrain says, you can be 20 and regret a lost childhood. I am 45 and I wish I were 35 like Aprilrain, but I know women who transitioned at 55 and 65. To me, and I could be wrong about this, the idea of it's now or never, raises major red flags. The problem is that there is that never is in the equation, which means that transition is optional. If transition is inevitable, on the other hand, what is the difference between 6 months or 18 months or, in my case, 5 years? It was going to happen anyway.

[Kaitlyn Michele]

i think its reasonable to let money in the equation...its a risk though...in the best case the SOC (imperfect as it is) should guide professionals and trans people, but should not be a decision maker..the decision maker is you, the person. it is your life..
when i have argued that it's my life, and here's what i am doing to everyone, its hard to argue against another person saying the same thing but doing something different than me..

that being said, the risk of getting caught up in the money is real.....money clouds judgement..
buying therapy letters is an extreme example.....so all one can say is going to fast is a risk...ignoring the SOC (Which hate it or love it is put together by a large group of experienced and caring people that know what they are talking about) seems foolish..

Waiting to be diagnosed is a personal issue...i hate the whole concept of being "diagnosed".. but i love the idea of communicating your experience, and comparing it to others...and being honest with yourself..
it think in your case beth it is in your hands more than you think....

i agree at your age this is a charged issue...stand up for yourself...analyze yourself.. you know the SOC, you can read all the docs, it is YOUR sense of urgency and your life...
if you are expressing this urgency with no satisfaction, move on...nobody says this easy...but if you are ts and you aggressively make progress your rewards will be high...if you don't feel rewarded, its time to step back, its not a therapy issue...

[HenryHall]

... Waiting to be diagnosed is a personal issue...i hate the whole concept of being "diagnosed".. but i love the idea of communicating your experience, and comparing it to others...and being honest with yourself..
it think in your case beth it is in your hands more than you think.... ...

The SOC is inherently a medical document, it contains the texts

... Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available.
...
... The criteria for hormone therapy are as follows:
1. Persistent, well-documented gender dysphoria; ...
...
Criteria for mastectomy and creation of a male chest in FtM patients:
1. Persistent, well-documented gender dysphoria ...
...
Criteria for breast augmentation (implants/lipofilling) in MtF patients:
1. Persistent, well-documented gender dysphoria ...
... and so on for hysterectomy,ovariectomy, orchiectomy metoidioplasty, phalloplasty and vaginoplasty ... {emphasis was added}

Thus, the SOC is crystal clear, for these treatments Gender Dysphoria is not only required to be diagnosed, but required to also have a documented history. Diagnosed as Gender Dysphoria. And, as the SOC later asserts, Gender Dysphoria can only be diagnosed and documented by mental health professionals with documented credentials. Crucially, there is no "diagnosed" (scare quotes) about it.

The alternative is to dump the SOC and treat the mental health part of the "... transgender, transsexual journey ... " as a matter of human rights rather than as a medical issue. To be blunt, the unpleasant implication is that, through their gatekeeping antics, some psychologists have made themselves untrustworthy. The European Parliament sees it that way, but doubtless there are "experts" who will assert contrariwise. {scare quotes intended}
See Paragraph 13 of Recent European Parliament resolution
http://www.europarl.europa.eu/sides/...EN&language=EN

[Starling]

Because of the last decade's rapid expansion of TS awareness--and advocacy for insurance coverage--the counseling talent right now may be pretty thin on the ground. Fortunately, I'm mightily impressed with the "non-directiveness" of my gender therapist. I guess her thirty years of experience and education count for something.

Lallie

[Melody Moore]

Wow, some people here really just don't get it with the SoC and like to twist things around to suit their own agenda - sad

[Beth-Lock]

My case has been dragging on for six years...

As for the RLE, I am past two and a half years of living as a woman full-time. (I was dressing as a woman a lot of the time, though more discreetly for some time before that, and certainly within the home full-time, but I am not counting that.) Doing it full-time everywhere was a decision I took myself, being frustrated by the professionals. I have not regretted that, and am adjusting better and better, to life as a woman. I even belong to a women's group. Luckily I could pass well enough without the aid of FFS or the feminizing effect of hormones which I have never taken, again not by choice. A lot of trans can't pass like that, so I have been fortunate to have had the option.

I am not really complaining, but thought this might clear up some misconceptions about where I am coming from. I talked to another transwoman here who did get SRS, and she had to wait too long as well, and got it late in life. The situation here is we are poorly served as far as trans go, and I am not the only one to observe that. A friend was trying to get someone to set up a trans clinic here, but it never materialized. For a conurbation like ours of about a million people, that is a shame. (At the rate of one in a thousand, that means we have about a thousand of us here.)

[Fractured]

Wow, some people here really just don't get it with the SoC and like to twist things around to suit their own agenda - sad

Everyone has an agenda. I would be surprised if everyone believed the same thing, had the same perspective, and had the same goals. By taking everyone's perspective into account, particularly dissenting ones, we can learn more about the world around us. I would hate to disregard valid considerations and stances. Group-think has led to many bad situations.

I can understand and empathize with someone's viewpoint even if I don't agree with it. Just because I hold a different perspective from them does not invalidate their points nor does it mean mine are more (or less) valid.

And so far, I really haven't seen any true disagreements in this discussion. It seems more that everyone has a different take on the discussion and are arguing on separate points that have yet to truly conflict. The biggest sticking point seems to be the "need" to have an enforced SOC that requires the "intervention" of mental health professionals to allow HRT and SRS/GRS. One side is arguing the SOC is good for providing structure and assurances while the other side argues that mental health professionals can be blockers since it requires a diagnosis of mental disorder (an anathema to a sane person) and support (via letters) to allow "treatment" (and that there are those professionals who will not provide such based on personal beliefs/opinions).

The side discussion on cost of care and the health system through which it is provided seems just that, a side issue to the main discussion.

Is that an accurate assessment of the debate thus far?

[HenryHall]

Everyone has an agenda. ...
Is that an accurate assessment of the debate thus far?

It's an excellent essay précis and it is substantially more right than wrong.

You might add that some hold that the SOC fails to comply with international agreements and treaties on human rights. UDHR(1948) and more specifically ECHR(1953).

[Kaitlyn Michele]

Luckily for me the SOC and WPATH didn't stop me.
nobodies agenda was gonna stop me..words on a piece of paper didnt impact my fundamental human rights..

I took personal responsibility for my life and my identity. And i help others to do so now.

There are so many helpful people out there, you have to find them. If you can't, its on you. If you let the SOC stop your transition, its on you.
If you don't have the money for transition, it's on you. If you are afraid of the gatekeepers, it's on you.
Feel free to blame others, its your life..

There are no easy solutions...but its not somebody elses fault if you are stuck...read the SOC..its a good document...understand how it relates to you...talk to other transsexuals...learn from them ...know the medical implications, find a supportive doctor, there are tons of them...get unstuck..work with it or work around it, whatever suits your personal situation...but be smart and don't get caught up in how you don't like words on a piece of paper.

[Melody Moore]

There are no easy solutions...but its not somebody elses fault if you are stuck...read the SOC..its a good document...understand how it relates to you...talk to other transsexuals...learn from them ...know the medical implications, find a supportive doctor, there are tons of them...get unstuck..work with it or work around it, whatever suits your personal situation...but be smart and don't get caught up in how you don't like words on a piece of paper.

Thank you Kaitlyn - some people here forget that the SoC are only guidelines that health professionals are working with
and this is why I have an issue with Henry's outlook of the SoC here. Personally I think Henry doesn't like the new SoC
because it doesn't fit his personal agenda. And according to him it doesn't comply with the ECHR(1953)? You really have
got to be kidding me. Poor Henry does not feel the SoC are fair and equal to all? FFS!

[Fractured]

I will admit that, as a citizen of the US, I am not as versed in international law as some of ya'll are. I did a quick read through the UHDR and a glance over the ECHR (which as a European document has no authority in my country) description on Wikipedia and in that admittedly brief review I found little to nothing specifically calling out medical coverage as a right (or anything else I could conceive being related to the SoC). Granted, courts can say a provision covers a certain case (such as the US Constitution not calling out protection of reasonable expectations of privacy but the US Supreme Court has ruled that it does) so the fact that something isn't specifically stated may not mean much.

That aside, for me personally, I like the SoC. It provide a framework that I can understand when my healthcare providers say they adhere to it. It provide a structure I can fall back on to say that a minimum amount of reasonable effort was made to make sure that transition is the right course for me. And I acknowledge that others may not want to adhere to them, so I don't expect them to. It is their right not to do so.

[HenryHall]

... the SoC are only guidelines that health professionals are working with and this is why I have an issue with Henry's outlook of the SoC ...
And according to him it doesn't comply with the ECHR(1953)?

I agree that you have an issue with my outlook.

Let us agree to differ as to whether the SOC complies with ECHR(1953). I find it sufficient the the European Council (47 nations) and the European Parliament (27 nations) have recently (in the last 90 days) passed resolutions that take my side.

Big girl panties notwithstanding.

[Beth-Lock]

I think it is more signifcant than many give credit, that the new standards would accept gender correction surgery without hormone administration. Physically, this of course might be problematic, but used to be the way it was done originally.

[Kaitlyn Michele]

I think it is more signifcant than many give credit, that the new standards would accept gender correction surgery without hormone administration. Physically, this of course might be problematic, but used to be the way it was done originally.

I didn't know that Beth..that's pretty interesting...i do know that years ago they based decisions around transition on how you looked...
i would have never passed muster back then...too tall...next...

it is interesting that regardless of how its viewed today, it has changed alot over the years, and will possibly change alot in the future..