Of course being a hypochondriac helps too
Of course being a hypochondriac helps too
I am always amused when someone opposes "Informed consent" to Standards of CareOriginally Posted by JohannaH
WPATH and the other standards bodies of which I am aware advocate informed consent within a set of minimum standards for the care of the individual.
It is not either/or, although "informed consent" can sometimes be a euphemism for buying your way past ethical standards.
Last edited by Rianna Humble; 09-24-2014 at 01:59 PM. Reason: Wrong word choice
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This above all: To thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any
Galileo said "You cannot teach a man anything" and they accuse ME of being sexist
Never ascribe to malice that which can be easily explained by sheer stupidity
Especially to us non-Americans who have a very different relationship with the medical establishment.
As far as trans health care is concerned "informed consent" as a standard is always a euphemism for buying your way to a result. Informed consent is a legal term that is used in the analysis of treatment gone wrong. For this reason courts have insisted that before every operation the patient or the guardian of a patient must be informed about the risks and benefits of the procedure and must consent to the procedure being performed.
In trans health care this term is used that once you waive all liability of the treating physician they are obliged to give you what you want, without any needs of benefits assessment. Those that advocate for this model are usually those that might fail in the WPATH assessment model which is considered a gate watching or gate keeping model to ensure that diagnosis, benefits and risks are balanced.
Historically, the wait times advocated by WPATH, surgeons etc. did not exists. They were instituted by psychiatrists doing assessments to better get a grasp on the need and intensity factor which is part of the diagnosis.
"Never forget the many ways there are to be human" (The Transsexual Taboo)
I would not facilitate access through any kind of insurance system or national healthcare system. These exist to fund treatment of medically-necessary conditions, address certain social concerns on which there is sufficiently broad public health agreement (e.g., birth control), fund services related to medically necessary care, etc. Funding for increasing the capacity of the healthcare system itself and reducing wait times is a separate issue. I understand that extended waits result in pressure to open access elsewhere, but that doesn't justify opening funded access for non-medically necessary services.
Some procedures can be and are treated as both medically necessary or elective, depending on circumstances. Elective access to these appears to be based on lack of harm relative to those which are more consequential or dangerous. We allow aspirin. We don't allow narcotics. (Please don't counter with culture-laden examples like alcohol.) BAs can be cosmetic or reconstructive. I would put SRS way of the range of elective acceptability. Hormones? For me, the answer is still no elective access and again, a major reason is the demonstrated inability of most people to offer truly informed consent.
Over the counter access is out of the question. Not only are these drugs powerful and potentially dangerous, as Frances rightfully points out, their use is properly monitored (blood tests) and a regimen personalized by a knowledgeable professional as well. I.e., administration needs to be regulated (in the medical sense). That situation is not amenable to open purchase and self-administration.
That leaves the last frontier as free access to elective (in the strict sense of not being medically indicated) hormones through medical providers. But the thing is, WE ARE ALREADY THERE in a practical sense. You want them, you can get them. Period! The complaint is more a matter of having your cake and eating it too. People want them the way they want them, i.e., as if they are entitled to medical services as if doctors were beauty salons or something. And you cannot demand elective services in this way. There are two sides to the elective coin, and the providers have as much right to impose their own procedures, and accept or refuse patients as you have a right to ask.
Lea
Here's the thing though.
Some people are having to choose between medication, food, or rent.
It's easy for some people to say that transpeople should pay out of pocket but usually they are the ones that are more or less financially stable.
The world is still unkind to us and many are unable to find a job let alone finding one while being visibly trans, perhaps leading some into sex work or living on the street.
SRS Is a medical necessity in the same way as penile reconstruction would be for an 18 year old who loses his penis somehow, it's the right thing to do to improve a person's quality of life.
How many do you know that could cough up $10,000 to go overseas?
That's even if one is comfortable going overseas in the first place.
Who is saying that anyone should pay for anything out of pocket? SRS is paid for where I live. Since that money comes from our taxes (pooled resources), it seems all the more fair to make sure it's not a whim or that the patient is not simply tired of living up to perceived expectations of what a man should be in today's society, hence the need for prolonged observation and RLE protocols.
That's what I got from Lea's first paragraph, but then again I could just be interpreting it wrong.
I believe she was referring to merely meeting the "informed consent" bar. The point of getting medical professionals involved is to determine whether something is medically necessary, and at that point they're gatekeepers by design and for good reasons.
~ Kimberly
“To escape criticism do nothing, say nothing, be nothing." - Elbert Hubbard
A person of any age that is wanting to transition has to have a realistic and workable plan.Usually the older transitioners have more financial assets but a whole lot more baggage as well. Young people are often free of obligations,but lacking a plan that will ultimately bring them a "good life" has them rudderless. Occupation selection and the education and skills leading to them is a critical choice..But everyone here knows this stuff. If all medical help [to do with transitioning] were free,fast and easy,I still don't think everyone would be better for it. A person has to first have a plan on how they are going to be "successful in their new life"and then make that happen. My viewpoint anyway..
It SURE is my hair ! I have the receipt and the box it came in !
I can see that I wasn't clear enough.
I was differentiating the patterns of practice for elective, self-paid medical care from those provided in connection with 3rd-party payers. Third-party payer systems do not cover elective medical care, with very few exceptions, as I pointed out in my earlier response. Nor should they. Because of this, there is always a determination of need. Elective care does not usually interpose the need condition – though some providers may introduce their own requirements. The unrestrained access to hormones that is being discussed here is trying to have it both ways. That is, addressing hormones need and having 3rd-party pay - but without process around or evidence of need. It's simply an unreasonable thing to demand.
Having staked a position there, I turned my attention to whether hormones should reasonably be provided in the elective care model, need or no need. And my answer there is still no.
Lea
Why?
There are people who can't afford therapy, let alone hormones or hair removal.
I've read a lot more about financial concerns coming from young people than older ones.
Hell, for most FFS isn't even in dream territory.
I view all forms of mental health issues as important and needing coverage, gender issues are no different.
Even poor people deserve to be healthy.
I have no problem personally with free, fast and easy healthcare. Medically necessary healthcare, that is.
Fast can be as fast as capacity allows and determination of need can be made with the proper differential diagnosis and physical screens.
What's free? If you mean covered, then yes, medically necessary hormones should be covered. I don't know about you, but I pay thousands of dollars annually for my health plan. Other people pay through their taxes. Nothing free about any of that!
As far as I am concerned, meeting the two criteria above constitutes easy.
Lea
We do pay higher taxes, but that also means that the less fortunate can get decent quality care.
It's "free" in that everyone shares the pain and the care is there when you need it rather than when you can afford it.
From what I've read DIY is a lot more common in the US where people either cannot afford all the gatekeeping or there are no therapists or endocrinologists within a reasonable distance.
Now if someone ends up severely hurt due to physical issues then you're going to be paying way more through emergency care than you would if everyone shelled out for therapy and proper medical treatment in the first place.
Gatekeeping only works if everyone who has to go through it can afford it.
In Nova Scotia both cosmetic and reconstructive breast augmentation is considered "cosmetic" and therefore not eligible for funding.
In my province SRS has recently been recognized as a medically necessary procedure (it was considered cosmetic before). Interesting statistics though, the Department of Health and Wellness anticipates covering no more that 8 such surgeries per annum out of a total population of 940,000. This is based on statistics of all provinces covering SRS and amounts to 1:117000 of population.I would put SRS way of the range of elective acceptability.
Under the Guidelines for treatment of adult transsexuals doctors are required to go through a 15 page questionaire which the patient and the doctor has to sign. The patient must demonstrate that they understand fully the risks and consequences of embarking on hormones. To even be allowed to sign the questionaire you require a recommendation from a clinical psychologist that hormones are medically indicated. Then you have to go through the weird exercise of having your pharmacist tell you at excruciating length why you should not take them, in hushed up tones, sort of keeping his hand in front of his mouth, with twirling hand motions when indicating, you know, "down there" - it was so funny and both my spouse and I burst out laughing ......Hormones? For me, the answer is still no elective access and again, a major reason is the demonstrated inability of most people to offer truly informed consent.
"Never forget the many ways there are to be human" (The Transsexual Taboo)
The first and last time I went to my Pharmacist as a guy, he did something very similar then warned me they where for woman and things might change, it's a bit worrying he thought someone wouldn't know what they were taking.
I agree with you. I just feel [from observation] that many people have no plan as to how they are going to live happily ever after in today's mainstream world even if their transition was completely free.
It SURE is my hair ! I have the receipt and the box it came in !
There is an interesting correlation between reconstructive breast surgery and SRS in that both are regarded as critical to mental health. I'm really surprised that reconstruction isn't covered.
My consent form was a one-pager. The general approach was "you agree you've been warned ... sign here ..." But then, in the US it's not considered necessary to warn people that they will wind up shooting the puck like a girl. (obligatory Canadian hockey joke)
The most common reaction I get from a pharmacist is a quizzical look, perched on the edge of saying something. One did ask "have you taken this before?" Estradiol is still occasionally prescribed for prostate problems, so I'm sure it's the dosages that trigger the reaction.
I love the statistic! It's another tangle in the thicket of incidence, and it's a real outlier.
Lea
That makes me appreciate my pharmacists even more, I've been with them my whole life and I've gotten nothing but excellent service.
One of the older ladies working there filled my first prescription of spiro and said she had noticed the changes, she then wished me luck
Yesterday I went to the movies
I went to movie called Tusk... I was late and I was meeting two old horror movie buff friends so I went in alone (btw...it was a silly bad movie...!!)...
I asked for my ticket and the guy looked at me funny at the desk...he asked "....you do know this is a horror movie, maam????".........
My pharmacist only asked me if I had any questions the first time I had the prescription filled. I said no and that was that.
of course I was dressed as a woman, but the scrip was for Michael.
Last edited by Angela Campbell; 09-26-2014 at 04:48 PM.
All I ever wanted was to be a girl. Is that really asking too much?
My pharmacy tech asked me if I had any questions. I said no, and then she asked me where I got nails done. (This is the clinic pharmacy where they are used to customers such as I). The estradiol does come with a large sheet of warnings written in fine print which is there for me to read, along with an invitation to call the pharmacy if I had questions
You know, I hate that line. It's like the tv ads - "Talk with your doctor ..."
The problem being that most doctors don't have much time to talk and even fewer of them have any particular expertise in this area anyway. In my experience, pharmacists are very helpful and very willing! But they don't know anything about this practice area, either.
Lea
Not the case in my clinic. My doctor will do a phone consultation within a day or two of my request, and answers my emails promptly. She consults with the hospital's transgender team which supervises the treatment of about 100 patients a year. Hawaii is very accepting of the transgender community for the most part and medical care in this respect is probably a little ahead of the rest of the country. I'm very happy with it.
First I struggled with this for 52 years then went to a gender therapist for a year and half. Then I decided to transition and go on HRT. Started laser on my facial hair. But I did not have a lot of RLE. But three months after it became harder and harder to go back and fourth, then one morning I got up and could no longer be the person I was not. After a lot of crying I got went full time and never looked back! It's been almost a year and half and I'm on track for my surgery next year and I've never been happier in my life! There is no one way to do this, listen to your hart it will tell you what you need to do.
Janelle
"And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom" Anais Nin.
Live, Laugh, and Love Yourself!
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