Informed Consent System For Hormone Therapy

[Guest Jo-I-Dunno]

Okay. So I just got off the phone with someone from Howard Brown Health Center. Apparently, they have what is known as an informed consent system. I meet with doctors to see if I'm healthy enough for hormone therapy, and they draw my blood. While they're doing blood tests, I talk with an "advocate" who verifies that I am completely aware of the effects and risks of hormones, and then a week or two later I can pick up my prescription. I don't necessarily need to meet all the WPATH standards, but I'm sure they take it in to consideration.

Seriously, though, is talking to a woman for an hour about the effects of hormone therapy really enough to make sure I'm ready? I mean, I know I am, but it seems too easy for people who might not be.

On a side note, I made an appointment to begin hormone therapy! Yay me!

[Guest Elizabeth K]

I had that. But it was 22 forms I had to sign for my prescribing physician. Its NOT intended to be therapy - it's a CYA for the doctor! I suspect the medical insurance companies require this rigamarole!

Lizzy

UPDATE

I assumed you aleady had the approval letter for HRT from a therapist.

[Guest Donna Jean]

Okay. So I just got off the phone with someone from Howard Brown Health Center. Apparently, they have what is known as an informed consent system. I meet with doctors to see if I'm healthy enough for hormone therapy, and they draw my blood. While they're doing blood tests, I talk with an "advocate" who verifies that I am completely aware of the effects and risks of hormones, and then a week or two later I can pick up my prescription. I don't necessarily need to meet all the WPATH standards, but I'm sure they take it in to consideration.

Seriously, though, is talking to a woman for an hour about the effects of hormone therapy really enough to make sure I'm ready? I mean, I know I am, but it seems too easy for people who might not be.

On a side note, I made an appointment to begin hormone therapy! Yay me!

Honey...THAT is exactly my problem with it all...

We've had people who have come on this site and said that they were cross dressers and wanted to grow boobs...

Would they be able to start HRT? They wouldn't be truly Transsexual and it would be a HUGE mistake...

Other's think that they "want" to be woman and not that they "are" already a woman and need HRT...

I think that therapy first is a good thing...I know there are some out there that will say..."It's my body and decision..."..YES!

But therapy helps keep people from making mistakes that they will carry with them for the rest of their lives!

And, I feel that ANYONE that will be getting HRT should have at least some time with a therapist to get things set in their minds...after all...begining transition is life changing ordeal that's not to be taken lightly.....

Donna Jean

[Guest Camicochan]

Here's my opinion, as unpopular as it maybe. The WPATH is crap. It puts arbitrary limitations on what people can do to their bodies and when. What you do with your body is your personal decision and ultimately affects you.

Now therapy can be a very good thing and can help a lot of people. But why are transsexual people singled out for needing a therapeutic process for our medical needs? Men don't need therapy to attain Viagra, to help them better function sexually. Cis women don't need therapy to attain birth control, most of which is some form of female hormones.

How about surgery? You don't need therapy to get plastic surgery. Isn't it likely that some people who get plastic surgery will end up regretting it? We would say to those people well you made a personal irreversible decision, you should have thought it out more. There are virtually infinite ways you could make an irreversible decision in your life that you could potentially regret. Why, then, is gender singled out?

The population at large operates on a gender binary, and it's through things such as the WPATH that they continue to marginalize people that don't fit into that. Gender non-normativity is still something "other," and for someone to be like that it must surely be an "oddity," and they want to "make sure" they're really who they think they are. I think an evaluation of knowledge of the effects of whatever procedure or hormones is necessary. But the choice should be yours. You know, if a crossdresser honestly wants breasts, and has demonstrated knowledge of the effects of hormones, who am I to stop him? Society is way too scared of people not having a definitive gender. I have a friend who took hormones for a period of time, but identifies neither as female or male. Zie changes zir appearance depending on the context, and actually passes as both. And that's zir prerogative.

I said all that basically to show that it's only regulated because people still think gender itself should be regulated and controlled. That being said, I still went through the steps since it is the easier route and is basically necessary still. But I really hope that society opens up and this is no longer such a big deal.

[Carolyn Marie]

I hope I don't come across as wishy washy on this, but I think there is validity in both points of view.

I strongly agree that therapy is important and I will continue to recommend it. There are a lot of issues to deal

with beyond whether someone is or isn't trans, ranging from depression to coming out to family, to dealing

with how to integrate the female side of one's self with the male side that one has lived in all their life (and

vice versa for FtM's). One doesn't just throw a switch and...oilla!

That said, the "three month" regime recommended by the WPATH seems arbitrary and one size does not

fit all. Some trans folk don't have any side issues to deal with and truly are ready to start HRT at the drop

of a hat. It shouldn't take a G.T. three months to know if they understand what they're getting into.

Cami, you make a really good point that HRT appears to be virtually the only medical procedure that requires

an extended course of therapy (or used to). That does seem wrong and discriminatory. But I still think it's

a good idea for most people, for at least some minimum period of time, even two sessions.

Carolyn Marie

[Guest JD_Divine]

Jo... Ive spoken with Howard Brown people AND Center on Halsted people already but have yet to meet with them to talk shop. Altho I am persuing the opposite of your hormone regime (You were born with the things I want and I'd sell you my boobs and vajayjay for a cup of coffee and a pack of smokes if I could but ... nevermind) its nice to see others that are engaging with the groups I shall soon be experiencing myself.

On a slightly unrelated note... since I know you're younger than me... have you considered possibly attending monthly support groups? I have at least 4 meetings to go to next month and really would like to at least have soeone there that I have repore with as I have no personal Trans friends...

~JD

[Guest i is Sam :-)]

Yeah I mean clearly it can be very helpful in many cases, but like they don't force you to sit through x amount of therapy before giving you an abortion.

And some people may have spent years coming to terms with who they are before they start to action it, those people are probably ready, and some people have very strong established support networks and don't need as much help, other's tho can be completely confused.

Therapy, should be made available cheaply and easily to everyone, and come highly recommened but it shouldn't be mandatory. At the very minimum they could just say, have one session and if the therapist is satisfied that you know what you're doing then fine, if not they can recommend more, and you'd have to sign something to indicate it was AMA if you didn't

[Guest Jo-I-Dunno]

On a slightly unrelated note... since I know you're younger than me... have you considered possibly attending monthly support groups? I have at least 4 meetings to go to next month and really would like to at least have soeone there that I have repore with as I have no personal Trans friends...

~JD

I actually live in the suburbs and it takes me like two hours to get anywhere near Howard Brown, so I can't really attend any meetings yet. However, I'm probably going to IIT next Fall, so maybe we'll be able to hook up then.

[Guest ChalenAustin]

The last thing I want to do is sound confrontational but this is my opinion right now. (who know's it changes)

I don't think it's fair that other people can do whatever and not have to jump threw all the hoops that we have to.

Ido think it's better that we are usually made to do things the "right way" even if nobody else is forced to for other things.

It keeps our suicides % down lower post hrt & srs and b/c this very real to be a ts in the first place- it isn't rare for people to want t go on hrt that really and truly shouldn't be on it.

Whether they think they're trans or not or simply not to that degree.

We would lose alot more a lot faster if we made it easier and more people got on hrt, regretted it, raised our suicide %age and still tried to look like legitimate poeple with a real cuase for doing this.

I've seen alot of stupid people taking hormones or trying to that should never have gotten them in the first place.

I highly dobt it's to "control" gender even more.

Actually the control has been let go if you notice more and more doctors not requiring therapy aymore- just a signed informed concent paper. So it's not as controlled as before- it's actually the least controlled it's ever been out there.

If you wnat something bad enough you'll get it one way or another- and I'd say 50% of trans people in general pick that route.

I'm glad that we have a set standard (at least here) that for anyone who is truly ready and not going to be impatient or immature about it, is not that had to bear.

It is the individual's body- but who gets what and how they act/respond to it reflects us as a community on the whole.

Andwith more and more trans people "out" I can guarrentee you that all don't need hrt and srs that bad- or shouldn't be starting it at that point in time in their lives.

If hrt wasn't so "available" and knowledge of it was "everywhere" you'd be amazed at how many people would go on living just fine.

Some of us need it others actually don't but will b/c they can or think they do at that time.

And it gives us all a reputation socially and medically when they do.

[Guest ChalenAustin]

Sumary: people who do things just b/c they can or get caught up in the moment of it all 9/10 regret it.

The abortion comment made me think.

Personally I don't agre with it for me but I would vote for the chioce since some people it must be done.

Knew a story of a girl who got an abortion b/c she didn't want to raise a baby and have her parents know she had sex.

Many many yaers later- and she has never frgiven herself.

Ask anyone whose gotten one. An overwhelming margin are not happy with their chioce in hinsight but must cope with it.

Do you want that to be you on hrt?

[Guest CharlieRose]

Knew a story of a girl who got an abortion b/c she didn't want to raise a baby and have her parents know she had sex.

Many many yaers later- and she has never frgiven herself.

Ask anyone whose gotten one. An overwhelming margin are not happy with their chioce in hinsight but must cope with it.

Do you want that to be you on hrt?

Well, that wouldn't be me on hrt, because even though I did have therapy, it was very much my own decision to start HRT. I found out the risks and benefits, I thought through the consequences and how I'd like to be dosed, long before I started gender therapy. All my therapist did was agree that I was capable of making the decision and wrote me a letter. They remarked many times that I had apparently thought the process through and assured my parents that I wasn't making the decision rashly. I was 17 when I started HRT, btw.

Perhaps people who take personal responsibility are in the minority. But I think it's patronizing to say that we're incapable of deciding things for ourselves, and we need professional help to know if we're "really" sure. It's like when you come out to people pre-transition and they say, "Are you sure? I really think you should just try accepting yourself the way you are," even though they don't know half of it. Except, rather than a misguided but well meaning friend, it's the generally accepted standards of care created and adopted by doctors and trained professionals.

I agree with Camicochan. SRS and HRT should be treated the same way as any other type of semi-optional surgery. ('Cause in some ways it's a decision, but if you need it, you really do need it!) Those under 18 should need their parents' consent as well as their own, those over 18 should be able to do whatever they want as long as they've been informed/reminded of the risks by their doctor. By all means gender therapy should be recommended to anyone who isn't sure, but it shouldn't be forced on those who don't need it.

The abortion analogy is kind of a false one, because you don't need parent's consent to have an abortion. That can lead to teenagers doing what (some of them) do best: making rash decisions they keep secret from their parents. Every other medical procedure requires parental consent, for example, plastic surgery is sometimes performed on minors and can be done with parental consent. Abortion is exempt because it can be a trigger for abuse.

[Guest ChalenAustin]

I agree with you for those that don't need it.

Especially the people who have clearly shown their maturity and can show they didn't dream it up over night.

It's the ones who aren't truly trans or not really suffering from GID I was aiming at.

Is it just me or does there seem to be more and more?

I swear the people walking into my gay alliance just get stupider and stupider.

I never call people stupid. You should hear some of their reasons and even then there's no talking them out of it!

Sad.

Not for one moment was I talking about or meant someone who was certain they were transsexual in those posts.

[Guest JD_Divine]

Well, Im on the south side myself and plan to take the trains to the center. Its literally a matter of life or death and I either go to these places or... well, do not want to think of the alternative to be blunt. When it comes to necessity, any travel distance is worth it if its financially sound and the benefit is truly exponentially important to my well being.

~JD

[Guest ChalenAustin]

JD_Divine you are the exceptions I'm talking about!

Good for you, you know what you want and your rearin' and ready to get it! (hope I said that right..)

Best luck and wishes to you!

[Sakura]

the three therapist. i have seen in my transition have told me that less than 30% of all self proclaimed transsexuals dont truely want SRS and hormones and are hyped up by other transsexuals telling them how absalutely wonderfull it is, aka cheerleading most full heartedly believe its for them because they have been brainwashed to think that its the only thing that will make them feel right and rarely listen to them selves or are slightly confused about what they are but get pointed in the "that has to be what i am " direction. i have seen it so many times in chat and at meetings its almost sicking

srs and hrt are not for every body no matter how much they think it is and usually by the time they realize it its far to late to go back.

gender altering surgery and hrt is nothing like a nose job or a tummy tuck. it its not even on the same level of phsycological impact that it can have on you if you are wrong a nose job if you regret later oh well its still a nose. having srs and regreting it later is "OH NO MY PENIS IS NOW A VAGINA !!!"

there is no real way to cope with that and imagine it would be just as bad if not worse than having actual gender disphoria

the standards of care and wpath are a fail safe to make sure some one dosnt jump to a hasty conclusion that really does ruin the rest of thier life

Sakura

[Guest i is Sam :-)]

I wasn't using the abortion analogy as anything to do with parental consent, but because it is a life changing proceedure that can have dire consequences if you are sure, and yet they don't insist that you have to have therapy first.

Tho I do think there needs to be an exception to the parental consent rules, if a transgendered teen has only just entered puberty and can still stop it at this point and be given the chance to develop normally as their correct gender, we all know how much better it is for them, both psychologically and by avoiding the need for hair removal, preventing the voice from breaking which can't be undone, allowing at least some gender appropriate skeletal development, and if the case of FTMs can remove the need for surgery or at least greatly reduce the amount of cutting and recovery it will take.

But some parents will never, ever consent, is it fair for these kids to have to wait till they're 18, and then they probably won't have insurace it's a mess. There really ought to be a way to petition a panel of doctors and a judge or something to get permission to over rule the parent.

in the case of transsexuals not really NEEDING HRT, I suppose if you feel fine without it then fine, but if you want it anyway, what is the harm in trying it? it's reversible in the short term, you get to see what it feels like, and why if you were a woman would you want to be full of testosterone, even if it was ok. a cis woman wouldn't consent to being given T and blocking E, even if it would feel ok.

[Guest Liam]

But some parents will never, ever consent, is it fair for these kids to have to wait till they're 18, and then they probably won't have insurace it's a mess. There really ought to be a way to petition a panel of doctors and a judge or something to get permission to over rule the parent.

Minors present a tricky situation when it comes to health care. I mean, you need parental consent to so much as give a kid some Tylenol. Essentially, in the eyes of the law, children's bodies belong to their parents. It sucks and is completely ageist and all that, but that's how it is. Now, using the example of abortion, in most states minor children need to get parental consent, or at the very least parental notification, in order to undergo an abortion. However, if they don't want to notify their parents because they're afraid they'll get hurt or experience other negative consequences, they can submit some sort of appeal and appear before a judge, saying that they're able to make this decision on their own and they can't tell their parents about it for x reasons. Then it's up to the judge. This is problematic for reasons I won't go into, but they do provide a way out for teens in the case of abortion. Applying this to trans youth, however, would be much more difficult, namely because transition is not something you can really hide. If a youth goes behind hir parents backs and petitions to start hormones, the parents will inevitably find out. And that youth could be subjected to a lot of danger. Ze could be beaten, kicked out, or any number of terrible things.

Regarding the original topic, I am fully in favor of the informed consent model. I think therapy should be available and encouraged for those who need it, but like some others have said, no other form of body modification is so heavily regulated by the mental health industry. And with regards to the claim that people will regret taking hormones or having surgery and then commit suicide, I think that the number of people who commit suicide because they can't access hormones or can't find a therapist or doctor to work with them them would be much higher. Also, many people who can't access hormones through traditional means will turn to getting them illegally, which can be dangerous. I think the focus here should be less on the fact that an easier way of getting hormones will result in a few people with regrets and more on the fact that more people who need treatment will have access to it.

[Guest Perona]

I had to speak with someone at Howard Brown before I got my hormones too. The woman I talked to went over the risks, but she also asked me a lot of questions to make sure I was ready for the consequences of HRT.

[Sakura]

but why risk the lives and the well being of even a few for the needs of the lazy ? this whole process for those you have the heart, guts, determination and money can have this whole process done and over with in a year or two. if one is really seriouse can be on hrt threw a therapist in as little as three months

" And with regards to the claim that people will regret taking hormones or having surgery and then commit suicide, I think that the number of people who commit suicide because they can't access hormones or can't find a therapist or doctor to work with them them would be much higher.

yeah but then the number of people with it easily acessable to them would most likely increase the post op and hrt regret suicide risk with no one to minitor who's getting on them it may lower one number but will raise it in another area

and there is harm in trying it, to get all the effects you would really need to see, to see if its for you takes several months in that time you grow breast tissue that does not reverse damages your sex drive and can permantly sterialize you in as little as 6 months, and even more still it takes years of living as your chosen gender to really get a good grasp of if this whole thing is right for you

Sakura

[Guest JD_Divine]

Ooh another person with experience with Howard Brown!!! Im going soon and just love to see people with experience there

~JD

[Guest CharlieRose]

I agree with you for those that don't need it.

Especially the people who have clearly shown their maturity and can show they didn't dream it up over night.

It's the ones who aren't truly trans or not really suffering from GID I was aiming at.

Is it just me or does there seem to be more and more?

I swear the people walking into my gay alliance just get stupider and stupider.

I never call people stupid. You should hear some of their reasons and even then there's no talking them out of it!

Sad.

Not for one moment was I talking about or meant someone who was certain they were transsexual in those posts.

That's the thing, though, is how are you going to tell if someone is actually transsexual or just thinks they are without therapy? That's what the therapy is for. Unfortunately, you have to go through it to prove you don't need it, and that's what's frustrating.

I-is-Sam, I wasn't referring to your use of the abortion analogy, just Chalen's saying that sometimes people get abortions as teenagers and regret them. And ditto what Liam said.

As far as looking out for the people who've fooled themselves into it, really, they're adults, they should be looking out for themselves. No one forced them to go into it blindly. It's something they should take seriously and take responsibility for. Plus, who says that therapy will necessarily help that? There was one woman on here who regretted her surgery who said that her therapist just sort of said, "Well, of course you should get surgery!" Some less than capable therapists might very well tell people they must not really want to transition if they don't want to get genital surgery, pressuring them into getting it against their initial feelings. When it comes down to it, I feel it really should just be in our hands, just like it is with every other type of medical procedure.

[Guest Joanna Phipps]

Here's my opinion, as unpopular as it maybe. The WPATH is crap. It puts arbitrary limitations on what people can do to their bodies and when. What you do with your body is your personal decision and ultimately affects you.

Now therapy can be a very good thing and can help a lot of people. But why are transsexual people singled out for needing a therapeutic process for our medical needs? Men don't need therapy to attain Viagra, to help them better function sexually. Cis women don't need therapy to attain birth control, most of which is some form of female hormones.

How about surgery? You don't need therapy to get plastic surgery. Isn't it likely that some people who get plastic surgery will end up regretting it? We would say to those people well you made a personal irreversible decision, you should have thought it out more. There are virtually infinite ways you could make an irreversible decision in your life that you could potentially regret. Why, then, is gender singled out?

The population at large operates on a gender binary, and it's through things such as the WPATH that they continue to marginalize people that don't fit into that. Gender non-normativity is still something "other," and for someone to be like that it must surely be an "oddity," and they want to "make sure" they're really who they think they are. I think an evaluation of knowledge of the effects of whatever procedure or hormones is necessary. But the choice should be yours. You know, if a crossdresser honestly wants breasts, and has demonstrated knowledge of the effects of hormones, who am I to stop him? Society is way too scared of people not having a definitive gender. I have a friend who took hormones for a period of time, but identifies neither as female or male. Zie changes zir appearance depending on the context, and actually passes as both. And that's zir prerogative.

I said all that basically to show that it's only regulated because people still think gender itself should be regulated and controlled. That being said, I still went through the steps since it is the easier route and is basically necessary still. But I really hope that society opens up and this is no longer such a big deal.

Camiochan while I dont agree with everything that WPATH puts out, there are some good reasons for therapy in our case. Not all of us are suited to going the entire distance and for some it might be selfdestructive to do so. The standards are there to help weed out those who think what we do is fun and might be good to do for no other reason than that. They are there to filter out those with other things going on psychitrically and get them into the specialized help so that their transition can be as problem free as possible.

Yes having to jump through hoops and put up with gate keepers can be annoying but in the long run it is for our protection and the protection of the medical community after all if a person gets all the way through surgery and then has regrets because they weren't really transsexual in the first place, it won't be seen as the patient's fault by the courts it will be the doctor's fault for not screening well enough.

[Guest i is Sam :-)]

but why risk the lives and the well being of even a few for the needs of the lazy ? this whole process for those you have the heart, guts, determination and money can have this whole process done and over with in a year or two. if one is really seriouse can be on hrt threw a therapist in as little as three months

Lazy?!! You wanna throw that word around? What about the people who live 4 hours drive from their nearest GT? And what is people have heart, guts, determination and not money, they can't transition? Seriously how elitest are you?

Oh and it doesn't take 3 months here, well it might if I had the thousands of pounds to access private care, I'll almost certainly be on a waiting list for at least a year. And some people when they come to terms with what they are, can't stand to just wait around forever, and depending on their age and what's happening with their hormones there might be a clock ticking. How many members do we have here regularly talking about hurtint themselves or wanting to kill themselves because they see their body becoming more and more incorrectly sexed by the day.

" And with regards to the claim that people will regret taking hormones or having surgery and then commit suicide, I think that the number of people who commit suicide because they can't access hormones or can't find a therapist or doctor to work with them them would be much higher.

yeah but then the number of people with it easily acessable to them would most likely increase the post op and hrt regret suicide risk with no one to minitor who's getting on them it may lower one number but will raise it in another area

The latter number would never be anywhere near as big as the first one. It is and always will be an incredibly small number of people who aren't transsexual and are actually even capeable of considering the idea of having their sex orgrans cut off.

and there is harm in trying it, to get all the effects you would really need to see, to see if its for you takes several months in that time you grow breast tissue that does not reverse damages your sex drive and can permantly sterialize you in as little as 6 months, and even more still it takes years of living as your chosen gender to really get a good grasp of if this whole thing is right for you

Sakura

A whole lot of time is ideal, although I disagree with some of the RLE stuff, I mean what exactly am I supposed to discover about womanhood that I suddenly think is so awful I'd rather go back to spending my life in misery? RLE is not about seeing if you can get on being the opposite sex, it's about seeing if you can live with being a transsexual, plain and simple, if you can live with the lonliness and ostracisation, and constantly fearing that you'll be caught.

A couple of months on hormones will give you plenty of time to get a feel for how the new horbones affect how your brain and emotions work, and that is by far the mostly likely thing you would hit up against it and think, "no this is not for me" if you turned out not to be ts. You don't need to grow a pair of breasts to know what it would be like to have them, and the same with hair we can manage to imagine. More time would always be ideal, the ability to experience every aspect before we make a decision, If you could walk 10 miles in my shoes i'm sure you'd learn more than you could in 1.

But as far as a reasonable compromise as best as is possible in order to help people be certain, you can have some experience on hormones, most sources say that you have have 4 months of MTF hormones without any irrevesible changes. I don't know the case for FTM, I guess you might end up with a slightly lower voice forever, you can obviously get facial hair removed.

People take piercings out and have tattoos lasered off, and millions of people don't, I'm not really sure what my point here is, except that people get too freaked out about doing permanent things, Your parents tell you that if you get $$$$ tattooed on your butt you'll regret it the rest of you life? Well yeah people do, but they fix it or live with it. How many people jump off a bridge because of it? Bottom surgery is very hard to fix and impossible with current technology to do it well, but nobody's suggesting drive thru SRS. Just about everything else can be undon is if it really has to, in the very small group of people who would manage to get it so completely wrong.

[Guest Joanna Phipps]

Sam the group is small but it doesnt take too many malpractice suits to have the medical community running scared and looking for protection. As I have stated the standards are in place to protect us from ourselves and the medical community from malpractice and civil suits based on not screening their patients enough.

[Guest sarah f]

I just want to say, Congrats Jo on you about to start hormone therapy. If this is what you want than go for it. There is no right way or wrong way to go about it. I believe in going to a therapist first but if someone doesn't and knows all the risks than that is their decision.

Love,

Sarah F