Confused and Upset

[Cheyenne Skye]

I'm not going to comment on whether or not the therapist is right or wrong. I will just relate my experience. I was in therapy for slightly more than a year (weekly or bi-weekly sessions depending on scheduling) before hormones even became a topic of conversation. The first time I brought it up, my therapist said we would talk about it at the next session. But that was when things got really bad with my (ex)wife. So hormones actually got tabled for a few months. When it came up again we had a discussion about the Standards of care and informed consent. Once he was sure I knew what the possible outcomes could be if I took hormones, He wrote me "the LETTER". He mailed me a copy and put a note in my file. (I go to a clinic with both therapists and doctors who will prescribe HRT.) So I made my appointment with the doctor. When he saw me I told him why I was there. He checked my chart and said, "OK I'll write the script". That first year or so was mostly about how I could possibly express myself more and still satisfy my wife. (That didn't work )

Think about using your sessions to discuss the implications of taking hormones. How it will affect your relationships? What happens when the physical changes can no longer be hidden? Stuff like that. So you have options for whatever scenarios you might find yourself in.

[Nicole Erin]

Screw that therapy crap. CIS people don;t know squat about being TG.
You can just as easily get HRT off as website. Not the safest way but just a way to tide you over until this quack breaks.

Also, mention something along the lines of you were hoping to start HRT and how you will need a therapist leading up to SRS. Then say, "cha-ching". Your therapist will start thinking "more moo-lah for me, I better get this girl on some hormones quick."

Well, that is how an Erin would do things.

[Michelle789]

Tessa,

I'm sorry that your therapist doesn't get it. I agree with some of the advice here. You can still start on hair removal, and start growing your hair out. If you're comfortable only, you may start presenting as female on some occasions. You will probably want a wig since your hair isn't grown out yet. Losing weight is a great idea before starting HRT: it will be easier to find women's clothes that fit, and you'll be in better physical shape.

I would listen to Paula and see the recommended therapist in Tulsa. Even though it may be a bit of a drive from OKC, a good gender specialist that gets us is critical. I personally didn't need a therapist to get HRT letter. In California, you don't need a therapist letter and all you need to do is to go see a doctor, but many other states still require a therapist letter. A good therapist will be able to help you with the ins and outs of transition. Consider this a blessing in disguise; your current therapist probably won't be able to help you too much with your transition.

You don't need to go to therapy wearing a dress or heels. I went to my first 8 sessions in male mode, and only started presenting as female when circumstances would allow me too. In my case, there was a drastic change in circumstances in late May/early June of last year so I essentially went full-time; so essentially from the 9th session onward I've been dressing as a female. My therapist told me that she always saw me as a girl, regardless of how I was dressed.

Transition is a long process, with many ups and downs. Please feel free to send me a PM if you need to talk

[PaulaQ]

Gatekeeping works, and patience is the name of the game. Hair removal took me about 5 years. Start with that while waiting for the HRT go-ahead.

My first therapist tried this. She really didn't want to give me a letter for HRT - under any circumstances. I'd worked with her for months. By the time I finally begged her to give me the letter I had already found another therapist, and was ready to start over again. Had she refused, I would've had to start over with the new therapist. (I switched to the new therapist anyway - I'd moved out of state by that point.) And to be honest, I probably wouldn't have survived until my new therapist gave me a letter - it took me weeks to get in to see her, plus whatever time she'd have needed to make the determination. I was quite desperate, and hanging on to my life by my finger nails.

That's really the problem with gatekeeping. Some of us are pretty desperate by the time we start this. I know a lot of you may not identify with that, but it was my experience. After about two months on HRT, I felt normal. I'd never felt "normal" before, not once, in my entire life. With HRT, the depression, anxiety, paranoia, and other horrible emotional problems I had just melted away.

BTW, my therapist's objection had nothing to do with gatekeeping - she simply didn't want to take responsibility for my decision, and that a letter shouldn't have been required in the first place. Unfortunately, I was unable to find a doctor who didn't require a letter.

If I hadn't obtained HRT when I did, I'd have almost certainly ended my life - for real, and with finality, and not just attempted it. I was in so much pain.

BTW, my first therapist's initial diagnosis of me was that I was "gender queer." I dunno, take a look at my photos, and see if you think that makes any sense whatsoever.

So I'm sorry, but I think in terms of prescribing medicine, psychotherapists are useful for about one thing only - making sure the patient is not so badly mentally ill that they are unable to give informed consent. (Hint - most of us are sane enough to give informed consent, and it doesn't really take that long to figure this out.) Don't get me wrong - I love my current therapist, and have been seeing her consistently for 15 months now. She's great! I've learned so much about myself, and my gender, working with her. I feel therapy is a very important part of transition.

Should someone be tested psychologically to make sure they'll stick to a diabetic diet - or even made to follow the diet for a while - before being allowed to be treated medically for diabetes? (How many toes should they lose first, if so?)

[Frances]

There are tests for diabetes. All gender therapists have is self-reporting from the client. The client may report persistence, but how can the therapist witness it? If the client has been living in the target gender for a long time, the evaluation time can be shortened. But when confronted with a middle-aged man who invested his masculinity (got married, had children, functionned successfully as a man for over 40 years, etc.), how can the therapist differentiate between "not wanting to a man anymore" and "being a woman?"

I am not an American and do not believe in informed consent access if the client can afford it. The medical care for trans people, in my country, is in part at the expense of tax-payers. It is not to be meted out easily, especially in the absence of tests.

The government recently approved non-gatekeepers, and I am now seeing regretters: people who "knew what they wanted better the therapist." Detransitioning is not cool when you have had SRS.

I also don't buy into the "time is the essence." I know someone who threw away a referal for an endo because the appointment was in 6 months. He tried to get another one with a shorter wait. His therapist was one the newer approved fast-trackers. She had chosen that endo because of the wait; it was a diagnostic tool. The guy told me it had to be "now or never." He never transitioned, as should be.

I know this woman with gender issues who was dating a trans woman. She wanted to start HRT and transition into a man. She started showing up at group meetings and using a male name. She started therapy hoping to jump into HRT. After a few sessions, the therapist detected personnality disorders that were not merely concomitant, but that might have had motivated the desire to transition. The woman never transitioned and is quite happy now. She wanted to be trans to be a part of the community. In her case, HRT would have been irreversible and quite drastic.

If any of my comments on this forum rattle cages, then I am being useful. Transition is not to be taken lightly. On the other hand, if the intensity is strong enough, and the desire to transition has no basis in mental illness and personnality disorders, then my comments should have no impact.

[PaulaQ]

There are tests for diabetes. All gender therapists have is self-reporting from the client. The client may report persistence, but how can the therapist witness it?

So you think psychologists are qualified to diagnose physical medicine? That's what we are talking about here. Why don't they require someone with an MD?

If the client has been living in the target gender for a long time, the evaluation time can be shortened.

We are talking about HRT right? You mean Someone should have been living fulltime as a woman for a while, and that would just shorten the time in therapy? Seriously?

I am not an American and do not believe in informed consent access if the client can afford it. The medical care for trans people, in my country, is in part at the expense of tax-payers. It is not to be meted out easily, especially in the absence of tests.

That type of care isn't available in my country - even people who have private insurance often find that they have no coverage for gender related treatment. I thought about transitioning earlier in my life, but everything I investigated seemed to be designed to block me from obtaining it. Certainly the psychologist I saw as child in the 70's because of my gender had ZERO interest in helping me. Everyone wanted my "problem" to go away. So I tried to make it go away. This required a LOT of alcohol, as it turns out.

The government recently approved non-gatekeepers, and I am now seeing regretters: people who " what they wanted better the therapist." Detransitioning is not cool when you have had SRS.

I was talking about HRT, not SRS, breast augmentation, or FFS. None of the surgeons I'm aware of will perform SRS without a letter from a psychologist and a letter from a psychiatrist or PHd in psychology certifying extensive counseling, and at least one year of life fulltime, and a year on HRT.

I think that is appropriate - people do need to time to be sure this is right for them, and they can do this. I'm not sure why you are conflating gate keeping to start HRT with that for SRS. It used to take one year of living fulltime as a woman while under a psychologist's care here in the US before HRT could be started. Now tell me, in a country where, at the time there was NO protection legally for gender identity nor expression, prejudice was rampant (still is), does that even seem remotely fair? BTW, most places here in the US still offer no such protection.

I also don't buy into the "time is the essence." I know someone who threw away a referal for an endo because the appointment was in 6 months. He tried to get another one with a shorter wait. His therapist was one the newer approved fast-trackers. She had chosen that endo because of the wait; it was a diagnostic tool. The guy told me it had to be "now or never." He never transitioned, as should be.

So you just completely deny what I experienced? Do you think I'm lying about the serious emotional problems I experienced before starting HRT? Do you think I'm lying about going through therapy for several months, only to be told "Oh, I don't write letters!" I'd appreciate an answer on that.

I didn't wait so long to transition because life as a man was awesome. I waited because throughout my life, this just seemed impossible, and every avenue I ever investigated seemed designed to stymie my transition. I needed resources to pay for it, I had to find doctors to help with it (when I was young, information was hard to find). Once I had a kid, I felt obligated to be there for him. And since everyone told me this was just all some psychological issue or fetish, I felt I had no choice but to suppress it.

And so I did, until I reached the breaking point. This is not unheard of in the US, where getting proper medical treatment for gender conditions has historically been difficult, particularly in conservative parts of the country.

So I'm telling you that I didn't have another 6-12 months to await HRT. I feel quite certain I'd have ended my life before that time elapsed. No one was more surprised than I was when 2014 rolled in and I was still here. I'd started HRT in August of 2013, and I got fairly immediate relief from the horrible emotional stuff I was dealing with. I haven't had a panic attack, or been actively depressed or suicidal in well over a year. The anti depressants and anti anxiety meds I was given DID NOTHING. Well, except for Xanax, which calmed me down or knocked me out - but then drinking would've done the same. That was certainly no way I could have lived my life.

So no, the medical establishment here in the US lost its credibility in my eyes when they refused to treat me as a child. They lost their credibility with me when I discovered that even today, I had great difficulty finding doctors who would treat me. Nothing against me, but lots of docs here don't want to treat transsexuals at all.

For example, my niece used to work for one of the best endocrinologists in the city of Dallas. She asked if would consider overseeing my HRT. He told her "no, but he'd be happy to treat me for diabetes, should I need that."

It's nice for you, I hope, that you live in a place where such medical procedures are well supported with public health care. Lots of us don't though, and that changes things significantly.

[Frances]

I actually don't see gatekeeping as a negative, and I think it applies to HRT. Again, remember that it's irreversible for guys. I don't think anyone should be fast-tracked into HRT, unless they have been living as their target gender for a some time. If not, then the therapist needs time to evaluate the intensity, persistence and possibility of concomitant metal illnesses.

I opined on protocols, rules and processes. I was relating stories of people I do know personally, not denying anything about you. Like I said, if you are sure about yourself and your path, none of what I say should matter. I am not a member of WPATH or John Hopkins or whatever.

[TessaOKC]

What a great debate this issue has turned into and I have to admit it really has me thinking!!

To make my point simple I will split transitioning into two categories: First, I think there are those, who without a doubt, have obvious gender dysphoria. They are already dressing, wearing make-up, came out to family and friends, and are very happy and content. Second, like me, there are those of us who are somewhat confused about our gender dysphoria and feel somewhat hesitant at first to consider the big jump of transitioning. The signs and symptoms of gender dysphoria are somewhat mild and the decision to transition might take a lifetime.

I have had gender dysphoria since childhood. I did all the man stuff to try to hide it, former Marine, retired police sergeant, so on and so on. I have to admit that I was initially offended at my therapist blocking the gate to hrt. No one wants to be told what to do, I know I certainly don't. This forum pushed me to think about the situation even further, with all the great responses how could I go wrong..... Many of you are very correct, "What's the hurry??" The excitement of transitioning can be overwhelming and entice one to go forward with great speed. Transitioning is probably the single most significant step one can take in their lives, all encompassing, leaving virtually no part of ones life untouched. Of course we need to be sure of such a step, we'd be fools not to be sure. Right??

So,,,, for girls like me, I need to breath slowly, open my ears and be ready to learn, especially about myself. With each step I become more entrenched and more convinced that transitioning is what's right for me. If I make the list of reasons to transitions vs reasons not to, the "Reasons to transition" list has become increasingly longer. Ahhhh, so I was correct in my self assessment. I was correct that I have been different my whole life. I am correct that I need to transition for me, my sanity and my happiness.