"informed Consent" Is Confusing My Therapist

[Guest Jo-I-Dunno]

At the Howard Brown Health Center, it's frighteningly easy for me to get HRT. All I had to do was see a doctor once who drew my blood, a therapist once who made sure I know the effects and consequences of HRT, and I'll be going to start HRT Tuesday. This has been a 5-week process; but if I had a more flexible schedule, I could have done it in 2 weeks.

This is blowing away my regular therapist. That's understandable considering the WPATH SoC, but he keeps referencing some unnamed, other standard. He says the other transsexuals he's worked with have had two or three therapists, a doctor, and a team of coaches to teach you how to walk, talk, and dress, and over a year RLT to start HRT. He seems to think this huge "team" of people is normal and some sort of standard that everyone has to follow. I keep telling him I've never heard of anything like that; he's crazy!

Apparently, he was telling my parents this too. Because in February or so I asked my mom if she'd stop me from starting HRT if I pursued it and she said I'm an adult; she can't stop me. But she thought it'd take me years to get to that point and I wouldn't be able to do it. So now that it was so easy for me, she is freaking out!

I understand it was really easy for me, but how the heck did any expect it to be that hard?

[Guest Donna Jean]

This is blowing away my regular therapist. That's understandable considering the WPATH SoC, but he keeps referencing some unnamed, other standard. He says the other transsexuals he's worked with have had two or three therapists, a doctor, and a team of coaches to teach you how to walk, talk, and dress, and over a year RLT to start HRT. He seems to think this huge "team" of people is normal and some sort of standard that everyone has to follow. I keep telling him I've never heard of anything like that; he's crazy!

No...no...no....

I've never heard of that...

Maybe somewhere, I know that Joanna had a Gender "Team"...but all of that other stuff?

I had a therapist...got a letter....I have a gender doctor that prescribes my HRT..that's it!

Hon...I've read a LOT of posts here over the last two years...never heard of all that...

Me, Lizzy, Sally, Carolyn...(1) therapist....(1) Doctor....... Period!

He may not be crazy, but he's very uninformed!

HUGGS!

Donna Jean

[Guest Ryles_D]

Unless you've been doing RLT that is disturbingly easy... I've seen people start on hormone blockers with that, but the SoC really do expect at least 3 months of something like therapy, RLT. Unless your regular therapist counts as the 3 months of therapy. If so- awesome, that's about right. If not- that's kind of weird, but as long as they're competent, it's not bad.

And I've never heard of what your therapist has seen either... A year of RLT for HRT? I've seen that happen in the UK where they've got the postCode lottery going on... but not in the US. Are you sure he's not confusing it with lower surgery? Because you do need 1 year RLT for lower surgery and 2 therapist letters- but certainly not for HRT. And I've also never heard of the team of coaches. Some people get professional voice training and there are things out there to help- but everything else they're on their own more or less. O_o That's very odd.

[Guest Jo-I-Dunno]

Unless you've been doing RLT that is disturbingly easy... I've seen people start on hormone blockers with that, but the SoC really do expect at least 3 months of something like therapy, RLT. Unless your regular therapist counts as the 3 months of therapy. If so- awesome, that's about right. If not- that's kind of weird, but as long as they're competent, it's not bad.

And I've never heard of what your therapist has seen either... A year of RLT for HRT? I've seen that happen in the UK where they've got the postCode lottery going on... but not in the US. Are you sure he's not confusing it with lower surgery? Because you do need 1 year RLT for lower surgery and 2 therapist letters- but certainly not for HRT. And I've also never heard of the team of coaches. Some people get professional voice training and there are things out there to help- but everything else they're on their own more or less. O_o That's very odd.

I'm sure he's sure he's not confusing HRT with SRS. But I dunno. He said he'd give me a copy of whatever he's reading.

And the therapist at Howard Brown did ask if I was in therapy, but I got the feeling she'd okay me for HRT even if I wasn't. But she did get the sense I was informed, so maybe that's all it took.

[Carolyn Marie]

I second what Ryles and Dee Jay said. The SOC are guidelines, not laws. Therapists and doctors can vary their approach and still be OK. The group my G.T. practices

for does not issue "letters" per se. They no longer wish to be gatekeepers, and have found some doctors willing to go along with that approach. But most G.T.'s do still

issue letters, and most doctors still require them. The time necessary for therapy can vary a lot.

But like the others, I have never heard of anyone insisting on some giant team approach to this. That would make even getting to HRT prohibitively expensive and

time consuming. Two or more therapists for HRT? Nonsense! I think he's confusing HRT protocols with those for SRS. Ask him to show you a copy of

the standard he is following. It shouldn't be a secret. That would be interesting to see.

Carolyn Marie

[Guest Girl Emily]

I just read an interview with a gender therapist from San Francisco that was done in 1997 and his major complaint with forensic psychiatrist was how they expected a year of RLE before recommending hormone therapy as if the clients were criminals and needed to prove their transgenderness. I believe that during the heyday of university gender clinics the approach he described with a team was common so he may have dated his experience and lack of current knowledge of transgender treatment procedure as outlined in the latest SoC and its increased flexibility and understanding of how the "Gatekeeper" role effects the therapeutic relationship.

I don't know what to say to your mother. Maybe time will help that without making it a big deal. They sound supporting overall. Congratz on passing one of many hurdles.

Huggs,

[Guest Michele H]

Yes - this is a hold over from the University Program days and while the University of MN doesn't do surgery anymore, they still have a program that seems to have kept at least some of this mentality. I can't comment from experience but from what I have heard, if you get sucked into the U's program, you become a lab rate and are passed around for all the grads to practice on and they keep their hooks into for years.

[Guest erikka2046]

Unfortunately there still some institute using the old standard. The CAMH (formely called Clarke Institute) in Toronto still have these criteria posted on their site:

"Clients become eligible for hormone therapy after one-year of completion of living full-time in the felt-gender role" link: http://www.camh.net/Care_Treatment/Program...riasurgery.html

I did saw a psychiatrist and he would like to refer me there and told me the same thing like Jo-I-Dunno.....a team of specialists........but I said thanks but no. He did tried to convince me to go to CAMH and said clients don't like it because they cannot follow their protocol. I thought....try their medival protocol? No way. I think maybe GID is not their common daily practice and its seems some therapists lack of current knowledge of transgender treatment procedure.

I am now on the waiting list to Shebourne and may be able to see an endo earlier as my family doctor can refer me to one.

Erikka

[Guest Elizabeth K]

I second what Ryles and Dee Jay said. The SOC are guidelines, not laws. Therapists and doctors can vary their approach and still be OK. The group my G.T. practices

for does not issue "letters" per se. They no longer wish to be gatekeepers, and have found some doctors willing to go along with that approach. But most G.T.'s do still

issue letters, and most doctors still require them. The time necessary for therapy can vary a lot.

But like the others, I have never heard of anyone insisting on some giant team approach to this. That would make even getting to HRT prohibitively expensive and

time consuming. Two or more therapists for HRT? Nonsense! I think he's confusing HRT protocols with those for SRS. Ask him to show you a copy of

the standard he is following. It shouldn't be a secret. That would be interesting to see.

Carolyn Marie

I agree whith whall all here have said - and I think Carolyn comes close to what I would have writen if I had gotten on earlier.

My therapist - a PhD specialist in Gender Disproria issues - says the SoC is a guideline - and she even says it it somewhat out of date. Her recommendation to the Prescribing Physician - that I be allowed HRT - came after the second session - and she said it was obvious I was transsexual. I had gone the 'brutally honest" route on the advice of my post-op friend Veronia - and she was right! I THINK MY THERAPIST KNEW I WOULD JUST GO 'ILLEGAL' OTHERWISE - AND I WAS DESPARATE - PROBABLY WOULD HAVE DONE THAT. [this was before I had joined Laura's and found out about how dangerous that would have been]

And so it's a matter of judgement n the eyes of the therapist.

[Your therapist is 20 years behind!]

And she later told me offering HRT was a sort of test - to see if I was ready. I cried when she offered - said yes yes yes!!! NO hesitation. That it seems is one of the reactions she had found typical of true transsexuals.

And my prescribing doctor interviewed me again - even with my letter, and the fact that he works closely with my therapist. I just told him the same things - he had me sign 23 forms - I was on my way!

And he tested me in his own way - said I could get an orchi right then! I said it sounded good, but my research showed an orchi had to be performed in a way so not to interfer with SRS. I guess he wanted to see if I had a typical male reaction to having your manhood cut off - I didn't flinch. I WANT it gone!

So it's a game.

And the HRT is not permaneent for a few months. A person can back out. I think the "T" in the HRT is both for 'treatment' and for 'therapy.' It's kinda a test- because after starting HRT the 'reality' of what you are doing kicks in 100%. You REALLY have to think that out.

AND

RLT is also something that has to be tailored for the individual. And to thing we have to be 'coached' to be female is also 20 years out of date! We are already women. We tap into that and it all just happens! Plus - like my therapist says, and I agree, on HRT we definately become 14 year old girls - we 14 year old girls watch other women and talk with each other, to learn to become as feminine as we want to be - to learn that way - to fine tune what is already within us. Coaching? I guess it is okay - but in the world of today's resources, particulary the internet and place's like Laura'? Why spend the money?

I LOVE RLT! But it is really hard to make it work all the time.I guess that is the point! BUT why have RLT when not on HRT? Its like trying to learn to walk again, BEFORE corrective sugery! 'Ms. Lizzy, we will replace that defective hip, 'IF' you show use you will be able to walk with it by walking now!" DUH - what?

My opinions

Lizzy

[Paula ult]

My therapist follows the SOC, you have to go before their gender team to get your letter for HRT, my gender team is made up of other therapists from my therapist's office they have little to no involvement in my case except for reviewing it and interviewing me, after 3 months i got my letter, they waved me going before the gender team, the SOC does allow this, for my 2 letters for GRS i do have to go before them, my therapist is part of the team and says it is not that big a deal and really just a formality, this part is mainly to cover themselves in case i decide to sue them later.

I had no team nor did i need a team of people to help me transition, other than my Endo and therapist there was no professional team approach.

I suppose the world is my team, women in general, my hairdresser, manicurist, electrologist, all the people that support me and of course everyone here at Laura's you all make up my team.

Paula

[Guest Melanieshaman]

No...no...no....

I've never heard of that...

Maybe somewhere, I know that Joanna had a Gender "Team"...but all of that other stuff?

I had a therapist...got a letter....I have a gender doctor that prescribes my HRT..that's it!

Hon...I've read a LOT of posts here over the last two years...never heard of all that...

Me, Lizzy, Sally, Carolyn...(1) therapist....(1) Doctor....... Period!

He may not be crazy, but he's very uninformed!

HUGGS!

Donna Jean

yep 1 doc 1 shrink lol

My doc said all it takes is two people to concent to srs, and one has to be a medical doctor, so i am set (when the time comes)

Melanie