Considering Transition

[Marleena]

I replied yesterday but it went ignored so I removed it. Paula I'm seeing some positive things here. You're getting help, you said you joined a support group, you've made a long term transition plan, etc. Talk to people in your group that are at least in RLE for leads to gender therapists and for advice.

The most important thing now is to find a gender therapist with experience. If you have to travel far just consider it a road trip for the day and there will be time between visits anyways. Like Kaitlyn said there are therapists that do skype, email and phone therapy. Make the gender therapist your top priority. I also like the mini vacation at least, getaway that Mary mentioned. Think short term right now since your long term planning is done.

Cisgender people you know will be of little to no help because they just don't understand gender issues. They will want you cured instead which is the wrong approach to gender issues.

[Badtranny]

Paula, consider this.

The "letter" is not the goal of any Gender therapist you're going to encounter. They are supposed to help you through feelings of confusion and emotional discomfort, but the 12 weeks it takes to get a letter is just a guideline. Nobody can really diagnose anyone with something like this in 12 hours so what they're trying to do is identify people with OTHER problems that may be confusing the issue. Any therapist will tell you that YOU are the only one that knows what you're feeling and YOU are the one she is relying on to give her honest information about what you're feeling. If you find a therapist who agrees to give you the letter in 12 weeks, then go ahead and ask her for it right up front, what's the difference if you're just going through the motions? I told my therapist that I needed to be sure I wasn't crazy before I went and blew up my life with the transition. I was worried that I wasn't clear headed enough for the decision. She eventually said I was fine. She didn't say I was TS, she said I was of sound mind as far as she could tell.

Having said that, there are plenty of Endos who don't need a letter. Mine doesn't, and neither did my first Endo who was my GP at the time. In fact, I've had 3 Endos and none of them needed the letter. None even asked for it.

[LeaP]

Exactly right, except that I would change "any Gender therapist" to "any LEGITIMATE Gender therapist." Hormones didn't come up with mine until nearly 8 months in, and *I* brought it up. I started therapy with the goal of clarity. My therapist was principally concerned in the early months with treating other issues in order to see if the gender/sex issue remained and in what form.

My physician (who is trans herself), however, absolutely requires the letter.

[Angela Campbell]

My therapist asked me right up front what I wanted. I told him I wanted to transition. We discussed this with the reasons why, the ramifications and a lot of discussion on my past and why I wanted to. He also had to make sure I knew exactly what the effects and risks of HRT are and what my plans would be for coming out to family, work and everything else. We discussed my plans for what I will do after starting HRT. Of course this was not done in one visit but took several visits during a condensed period. We were meeting more than once a week. It took a little more than 6 weeks to get the letter. The 12 weeks is a guideline but an experienced therapist is not forced to go by it strictly, but is responsible to make sure it is the right thing. That is what the letter is for. It is the way the Endo or Internist protects themselves from the responsibility of giving someone who is not right for it the treatment. The letter places the responsibility for the determination of whether the treatment is proper on the therapist.
The one I see only works with TS people and has transitioned himself years ago.

[LeaP]

Therapy for transsexuals is intended to be multidisciplanary. A letter does not release a physician from responsibility - far from it. The physician is as responsible as the therapist and a physician that ignores existing standards of care in the treatment of ANY condition does so at his or her risk. From the WPATH SOC (the one that usually applies in the US): "Mental health professionals who recommend hormonal and surgical therapy share the legal and ethical responsibility for that decision with the physician who undertakes the treatment."

[Angela Campbell]

If that were the case the physician would have to spend time with you in therapy and they do not. They have to allow the mental health professional make that diagnosis and then the physician is responsible for the medical part of the treatment. Not whether or not it is the correct path for the patient to take. At least this is what was explained to me.

[mary something]

I agree with tour point Lea and it is exactly correct that the physician is completely responsible for any treatment that the administer I regard less of the circumstances of the situation. I read Ellen's point and my understanding of her post is that many physicians require letters from a credentialed professional that the patient has their clearance for the treatment from a psychological perspective. There are many Dr's who have this requirement and like Ellen said they use this professionals opinion that the patient isn't presenting with a different condition that would mimick transsexuality and that the patient is psychologically healthy enough for medical treatment.
Your post adds the important caveat that the physician is responsible for their actions regardless. And Paula this is an important point. The best way to make progress towards tour goal is first to stabilize your personal life and get in an even keel. Its simply one if the basics tenets of triage. Stabilize the patient then determine necessary treatments.

Don't let the fact that a lot of people are advising caution right now discourage you. Like kaitlyn said you need to feel progress right now. No one us saying that you are wrong, simply saying that you have to start climbing a ladder at the bottom you can't start halfway up.

[ReineD]

Paula, if your wife is telling everyone that you are transsexual and are on the path to sexual reassignment surgery, you can be proactive and tell everyone that you are experiencing major gender issues and that you are seeking professional help, even if this means seeing someone regularly in the nearest city to where you live.

If your wife is telling everyone that you are questioning your gender and she is afraid that you will transition, this is true. She is afraid that you will transition and you are questioning your gender, or at least this was the case throughout the things you've said in this thread.

If you've already decided that hormones are the answer for you before having seen a professional who is experienced in this and also anxiety and depression, honestly I think that no matter what he or she says, if they don't agree with you, you will not have any confidence in them because you've already made up your mind. So then it is a question of contacting some of the members here who might tell you how to find doctors who do prescribe hormones just based on your say-so. Over time I've read from members here (I don't know if they ended up transitioning or not) that there are many such doctors in this country. As much as we like to think that everyone follows the WPATH recommendations, I don't think this is the case if what members have said is true.

I wish there was more research focus on the ways that brains are rewired in non-Type V and VI TSs who take cross-sex hormones. Most of the studies that I come across focus on the cosmetic changes and also report feelings of well-being, specifically as regards the reduction of male libido which I understand can be distracting among some XY individuals. I do wonder if these feelings of well-being might enhance rather than relieve the feeling that one was born in the wrong body, among people who are not Type V or VI transsexual.

It is known that in human adults, the volume of the brain and hypothalamus of males tend to be larger than those of females. Studies of transsexuals have shown that the brain of MtF TSs approximates the size of cisfemales' brains. I did find a study that posed the question, was the MtF TS female brain size present at birth, or was it altered as the result of HRT. The findings suggest that HRT does decrease the male brain size towards female proportions in MtF TSs. If these types of changes can occur, what else might be changed?

Here's the study: http://www.eje.org/content/155/suppl_1/S107.full

I also found an account of transition by someone born in 1965 who felt she was female as a child, began HRT in 2003, and had SRS in 2012. Her story is similar to other transitioners that I've read, but she did make a point that I've seen made in this thread several times and that I'd like to emphasize:

http://www.transvamp.com/ask/myths_hormones.html

Why Transition Won't Work for Most People

Some middle-aged folks transition for the wrong reasons. They feel they were born in the wrong body and must take the steps necessary to live their lives completely as full-time women. They go through all the steps - hormones, FFS, breast implants, vaginoplasty - only to discover that they feel no better than when they started. The reason is plain and simple. If your life sucks as a man, it will suck worse as a woman.

Although it's nice to receive encouragement, I think it is more useful to get both sides of the story so that you can make the best informed, most objective decision possible, since we are talking about drastic changes to your fundamental being.

I hope that you and others will not resent my suggestions to exercise caution, if you can.

[mary something]

There are a lot of people here Paula who care about you and want you to feel better very much

[arbon]

I agree with what Mary says about there being people here who care about you and want to see you get through this.

[PaulaQ]

Awake now. Took more Xanax this morning - I woke up having a panic attack.

I promise I will respond to everyone, please don't feel I am ignoring you, especially Marleena, but also everyone.

I am stuck. I need to be Paula for a while. It helps. I am afraid to be Paula - I somehow know all the feelings I've had about being a monster are right. I am a monster - hideous and deformed, and anathema to society. There is no place for me.

I should die.

I will try to be Paula today. I don't trust anyone. I don't know if I can be Paula. She is frightened, and that is new. It is weird to hide behind my natural face - it is a mask. I am myself after I don my garb as Paula.

Obviously time for more meds.

[Marleena]

No need to reply to me Paula it was mostly observation on my part.

[PaulaQ]

I'm better today than I was over the last couple of days. I'll respond in more depth later. I'm having trouble responding to some of the posts in the thread without triggering a panic / anxiety attack. That shuts me down for a while, so it's kind of pointless to try and write anything. Bear with me. Having a hard time still. I am fragile right now.

[Kaitlyn Michele]

paula you do not need to respond to ANY post ...
Take what you want out of each one!!! toss the ones that don't resonate...

people care to share and some of us may not have ever been in a similar place..

take a breather and start over...the past posts are the past

...what can you do now to feel better...to feel ok? there is no need for anything to happen today tomorrow or anytime soon... if you don't make progress today, maybe tomorrow or the next...

you have a lot to offer and you have a lot on your plate...you can hang in there for now!!

[ReineD]

If it was me, Paula, I'm sorry ...

Like Kaitlyn says, these are only things to consider and either follow through on or reject. You must follow your own heart.

[PaulaQ]

Since the subject of "what do you want from a therapist" has come up -

What I want from a therapist
1. A diagnosis
2. A treatment plan - preferrably one that follows WPATH
3. Guidance during treatment as appropriate - there are many decisions that only I can make, but help making them, and tools for making the right choices would help

What I don't want
1. Hints that I should self medicate
2. Suggestions that just seem bizarre - like voice coaching is a waste of money
3. Incorrect diagnosis like "I think you are genderqueer"? Really? NFW.
4. Actual pointers to local medical resources to help me, whatever my problem actually is
5. A kafkaesque process where "I am the only one who can understand what's wrong with myself, but if I guess wrong, then "you have a tendency to over-diagnose yourself and pathologize your condition" What am I doing? Do I figure this out for myself, or do I not? Apparently, both are the wrong answer.

Speaking of kafkaesque processes - this forum - yeah, I am tired of being on trial here.

I hope I figure out what's wrong with me. (I feel quite certain of it, but apparently I am the only one.) I hope I don't ruin my life. Since I am seriously considering ending it, I would hope it can only get better from here - but in fact I know full well, from tragic, real life, first hand experience that there are PLENTY of fates that are worse than death. Let's hope I don't find one of those, shall we?

[mary something]

you sound very frustrated because you aren't making any progress. Re-examine your actions that have led you to this point, then resolve to do things in a different manner and hope they result in a situation that works better for you. Isn't it safe to say that something needs to change? The only person who you can make change is yourself.

[Marleena]

A gender therapist is the key here Paula. They will be able to discern what is actually gender issues and what are other issues and treat you appropriately. They follow WPATH guidelines. We have given you ways to find one here in this thread.

[stefan37]

Since the subject of "what do you want from a therapist" has come up -

What I want from a therapist
1. A diagnosis
2. A treatment plan - preferrably one that follows WPATH
3. Guidance during treatment as appropriate - there are many decisions that only I can make, but help making them, and tools for making the right choices would help

What I don't want
1. Hints that I should self medicate
2. Suggestions that just seem bizarre - like voice coaching is a waste of money
3. Incorrect diagnosis like "I think you are genderqueer"? Really? NFW.
4. Actual pointers to local medical resources to help me, whatever my problem actually is
5. A kafkaesque process where "I am the only one who can understand what's wrong with myself, but if I guess wrong, then "you have a tendency to over-diagnose yourself and pathologize your condition" What am I doing? Do I figure this out for myself, or do I not? Apparently, both are the wrong answer.

Speaking of kafkaesque processes - this forum - yeah, I am tired of being on trial here.

I hope I figure out what's wrong with me. (I feel quite certain of it, but apparently I am the only one.) I hope I don't ruin my life. Since I am seriously considering ending it, I would hope it can only get better from here - but in fact I know full well, from tragic, real life, first hand experience that there are PLENTY of fates that are worse than death. Let's hope I don't find one of those, shall we?

What I want
1. a good gender therapist can give you an idea and ask good questions, but in the end you have to decide it transition is important to you.
2. Treatment plans goes as follows, seek therapy, commence facial hair removal the sooner the better. At some point be referred to a medical doctor for hrt. The timing of this is up to you.
3. guidance. Um this one is a bit tricky good gender therapists can make suggestions. A better way would be to get involved in transgender support groups and talk to other people that are or have transitioned and see what methods and techniques they used to transition.

What I do not want
1. Under no circumstances should you self medicate, the risks are way to high.
2. If your intention is to transition and you truly believe you are female, voice coaching, practice and use is of the up-most importance. It will not only allow you to integrate fully, but even in your daily life help you to feel more congruent with your true self. And voice practice cost zero money. There are plenty of resources on the web and YouTube that can get you started. The hard part is to practice and persevere. then when using it in public and on the phone overcome the self consciousness that accompanies using a female voice. Voice is so important and to improve it to sound female is not bizarre. Again no money has to be spent.
3. Again the diagnosis really has to come from you. You will know if you can live as a male, as female, or live in the middle. If you are not able to live in the middle switching back and forth, then I highly doubt you are gender queer.
4.Would it be better to not have access to local providers that may be able to offer assistance?
5. Medical doctors can pretty accurately diagnosis physical ailments and offer treatment. Competent therapists and good gender therapist if gender is involved can discover underlying symptoms and offer ways to mitigate those symptoms. Sometimes with medical intervention. Depression is a serious disease that can be diagnosed and treated.
If your gender is the underlying cause, you will need to decide what is more important in your life. Improving the quality of your life or maintaining the status quo and making everybody else comfortable except yourself.

Please do not feel you are on trial. We are offering suggestions to help you improve the quality of your life. Unfortunately on an internet forum you will get many opinions and some may or may not be in your best interest. You have to parse thruough the opinions and pick out those that resonate and are relevant to your feelings.

This is my opinion and only mine about why this is becoming so difficult for you. You have a loving wife that is not able to accept, support or be with you as you undergo transition. You love her deeply and the thought of you separating is too much to bear. You may feel guilty for shattering her views of your future together. Well unfortunately this condition in many ways really does suck and in the majority of cases despite the partners best actions the marriage is a casualty. That can not be avoided if you truly feel the need to transition and must transition to save your life. Ending your life is the most selfish thing an individual can do. It may help alleviate your feeling of pain, and who really knows what lies ahead after death, nobody has come back to report. But the heartache, pain and guild that it leaves with your survivors in its wake takes a huge toll on them and in many cases could scar them for life.

I wish you Godspeed in making the correct choices for you and improving the quality of your life. Yes you need to open up some serious decisions to make and opening up candid truthful honest conversations with your wife and deciding on a course of action, no matter where it may lead will be the best way for you to choose your path forward in life. Your wife may feel the need to pursue a different path, and it you take divergent paths, nothing says those paths may not at some point in the future converge again.

Good luck Paula, We truly only have your best interests in mind. I certainly have no agenda and offer these suggestions only to help you make what decisions are best for you.

[arbon]

1. Under no circumstances should you self medicate, the risks are way to high.

not as risky as ending things

[mary something]

that is very true Arbon! It might not be a very good choice but there sure are worse choices.

[LeaP]

paula you do not need to respond to ANY post ...
Take what you want out of each one!!! toss the ones that don't resonate...

Plus 1 on that.

[Maiko Newhalf]

Reine, could you please elaborate a little bit on the brain rewiring part of your post? (Maybe start another thread so we don't hijack the OP's thread) It got me a little bit concerned. It seems that it is a common practice these days (including in my case) for a gender therapist to use HRT as a "final" diagnosis tool to confirm GD. I've been going to gender therapy for almost two years and have recently started my full HRT. I'd say that I don't have much doubts since most of the other feminizing steps that I've taken such as facial hair removal and growing out hair did help a lot with my stress. I don't know why but seeing myself becoming more and more feminine just make me happy. I'm a firm believer of taking baby steps when it comes to a big decision and complicated task like gender transition.

With that be said, it concerns me if it is possible as the research article stated hormones could change one's brain. Then the whole thing could potentially be a self fulling prophecy...and also one could potentially use hormones to cure gender dysphoria. I'd like to know your opinion and other references if you have. I have to say 8 M2F and 6 F2M in that article is a bit of a small sample space....

I understand the topic is rather sensitive and you may not want to say something that upset other TS members. So feel free to PM me if this is the case. I really want to know...

Thanks,
Mayiko

[ReineD]

Maiko, I wish I could elaborate but I can't. My point was a question, based on the study that I posted. If HRT can change a TS's brain size, what else can it change in the brain in addition to all the desired cosmetic effects?

Also, I know that gender therapists use HRT as a diagnosis tool. I was shocked when I first heard this years ago but the theory is that if a person dresses strictly for sexual reasons the HRT will curb libido which will take away the desire to dress and I suppose bring the person a measure of peace.

[PaulaQ]

My understanding is that if you are TS, HRT will tend to calm you down, as it reduces GD. If you are NOT - you will tend to feel anxious and depressed - as the hormones induce GD. Because of the volatile nature of hormones and their effects on the body and brain, this is really only a good test if you already sort of know the answer anyway.