Importance Of Wpath?

[Guest Cody_T]

I'm looking into therapists, specifically either Los Angeles Gender Center or Southern California Gender Counseling

so, the second one says that it prepares you for "Gender Transitioning according to the Harry Benjamin

Standards of Care"

and the first doesn't mention this. I've kind of tried to figure out the difference but I'm still not quite sure which to go with... can you transition w/out the standards of care? And if so, were I to go to a therapist that encourages doing it w/the standards of care is that a waste of time/money?

Not to mention if anyone could quickly summarize what WPATH exactly does, ditto w/the standards

[Guest Evan_J]

http://www.wpath.org/publications_standards.cfm

If you go on the wpath site, the pdf version is free, download it. There is also a copy here on the site, its just easier for me to lay my hands on that one at the moment. Besides, if you go to the site you'll get to find out invesigate "exactly what is wpath".

[Guest Elizabeth K]

You can probably ask over the telephone what each group's standards are. I would suspect that if they are true gender dysphoric treatment groups there is probably little difference. No - you cannot transition without some version of Standards of Care and would not want to. Much of transition is one way, and a you need to be certain the path is right for you.

Any legitamate therapist will give you a few minutes on the telephone as they don't want to waste their time either.

Good question though - anyone else have an opinion?

[Guest Cody_T]

thanks for the link Evan, I couldn't find that for some reason

and I definitely will call them... if I get the courage to go that far

one more thing (which they might be able to answer, but I thought I'd try here) is that one of them has a surgeon associated with them, but I don't like his transster pictures (mostly keyholes anyway) and I want to go Brownstein/Perovic, so will the therapist/gender center have any say in what surgeons I can go to or who they would write the letter for?

[Guest Evan_J]

Not at all, wpath doesn't recommend or control which therapist you have, they are more a governing organization concerned with establishing a care guideline and protocol for the treatment of GID. The therapist you choose will either follow it or not but does not "come from" them. The way you're thinking of it is as if you needed to contact the AMA to find a family physician. Not at all necessary. Its just that a given sex/gender therapist will either follow or not follow their recommendations of a guideline when referring for hormones and surgery. Why is all of that necessary? The greater number of medical physicians who actually prescribe hrt for transsexualism or perform surgery for it want to be "covered" against lawsuits brought by patients who later "change their mind" or brought by their family in the event of death connected with either the treatment or the surgery. To safeguard that they ask for the letters to verify that they treated someone who very much so demonstrated an appropriate desperation/inablility to function without it whille simultaneously demonstrated enough mental stability to be judged "sound" in the making of the decision to take hormones or ask for surgery. Could a doctor accept such a letter from a therapist not following the guidelines? Sure. But under scrutiny in such a case there may be questions as to "how well did the therapist examine the patient before making the call". The wpath standards provides an "accepted" guideline that the therapist may have followed.

Are there doctors who will prescribe without letter, therapist , or anything else trusting only his own judgement? -and thereby "risk it all" trusting said judgement- yep. That's his call. Are there even surgeons who will likewise "risk it all" using personal judgement? In truth, yes. But they'll be even harder to find. Possession of the letters makes locating a physician willing to do the medical transition easier is all.

[Guest Little Sara]

The greater number of medical physicians who actually prescribe hrt for transsexualism or perform surgery for it want to be "covered" against lawsuits brought by patients who later "change their mind" or brought by their family in the event of death connected with either the treatment or the surgery.

If a surgery results in death, wether you followed the SoC or not is immaterial. Menopaused women don't need to follow SoCs to get HRT, which can still be dangerous. Intersex men and women, who may have no gonads anymore (removed, or non-functional), also do not need to follow SoCs. People who get nose jobs or gastric bypass don't need to have their mental health evaluated to "preserve against changing their mind". I don't know, a gastric bypass sounds fairly permanent and irreversible to me no?

The SoCs come to squeamishness and ignorance of therapists in the 60s (concerning transsexualism, gender, sex and such), and carry-over to now for no better reason than to have something. The 1 year RLT requirement has never been measured as being THE accurate measure. Basically, it's a number they made up and decided it sounded okay. Not the result of studies and recalibration of parameters.

If doctors and surgeons can worry about regrets following non-botched surgery concerning SRS, how come they don't worry about regrets concerning gastric bypass, nose jobs, breast augmentations (on cissexual women), breast reduction (on cissexual men) and all other matters of cosmetic surgeries that have various degrees of permanence?

People who have had regrets, such as Alan Finch and Charles Kane are pretty rare, and, sadly, have been stupid enough to create it themselves, by willfully lying to their therapists. That they turn around after and try to sue, they should sue themselves for being so unthinking. I heard Charles Kane quoted as thinking that being a woman meant "Having no stress, and shopping all the time." What planet was he on?

I attribute a large part of the fault to the DSM itself and therapists and activists who maintain that it's about gender roles. It's not. Sure, everyone should be able to pick which gender role fits them, but that has zero to do with the body. The concept of subconscious sex is willfully ignored by the DSM, who only mentions in passing that one of the criteria is disliking one's own male genitals (or vice-versa). Even that fails to convey how it feels. No wonder the Finch and Kane of the world go on thinking that "they can get an easy life as a woman" - no one tells them that it's not about gender roles.

[Guest Leah1026]

I have to disagree with the previous poster Sara.

In my opinion the SOC protect everyone: Doctors, therapists and US. Transition is a long, hard process. Following the SOC maximize your odds of a successful transition. Sure you can transition without them, but who will you have to turn to when something goes wrong? Nobody. When I was first starting out I read how many people committed suicide during transition or how some people had to transition more than once before they were successful. I set out to follow the SOC and hire a therapist to maximize my ability to be successful the first time. I carefully planned things out, took my time and succeeded. Transition is NOT a race. Although we may wish we could snap out fingers and be our true selves tomorrow, reality just doesn't work that way. Transition is also not just a physical undertaking, it is also a transformative mental change as well.

Also the SOC are not some monolithic monument. They have been revised 6 times, 6 times!!! The current version (v6 2001) are very patient friendly. Just about all the nastiness of previous versions are gone. There is also plenty of built-in flexibility now. For adults there are only two fixed rules (3 month evaluation prior to HRT and 1 year RLT w/letters). And both of those are flexible depending on your therapist.

The SOC is not the problem.

The only problem today is how some therapists and some countries interpret them. So if your therapist is being a jerk, get a new one. But if you're in one of those countries that impose there own additional rules there isn't much you can do.

The SOC are very necessary. For those who don't think so I have a useful quote:

"A physician who treats himself has a fool for a patient."

disclaimer: I am a medical professional (not a doctor)

[Sally]

"Gender Transitioning according to the Harry Benjamin

Standards of Care"

Not to mention if anyone could quickly summarize what WPATH exactly does, ditto w/the standards

The Standards of care were designed by a very well meaning man, Harry Benjamin, to protect us from ourselves. The guidelines were designed to give an individual multiple chances to stop before the surgery if they were mistaken. It also helps some people find their spot along the way if they don't require full transition. You have to work pretty hard to fool two therapists, live for a year as the 'desired' gender and spend a year on hormones and get your surgery (most doctors do a pre surgery interview to reassure themselves that this is the right thing for you.

WPATH continues from there and puts a set of guidelines that are accepted as the ones to follow and thereby protects the surgeon against a mal practice suit for doing exactly what you asked for, the same for your therapists and endocrinologist. They need to be protected, too. I saw an episode of "Sex Change Hospital" where Doctor Bowers had to turn down a young lady for surgery because she had hemophilia, it was under control, but the medical advisory board at the hospital could not allow it as none of their insurance would cover performing 'elective' surgery on a bleeder even if Marci felt that it wasn't too big of a risk. They have to keep the hospital going or no one can have their surgeries.

Does that explain it at all?

Love ya,

Sally

[Guest Little Sara]

I have to disagree with the previous poster Sara.

In my opinion the SOC protect everyone: Doctors, therapists and US. Transition is a long, hard process. Following the SOC maximize your odds of a successful transition. Sure you can transition without them, but who will you have to turn to when something goes wrong? Nobody. When I was first starting out I read how many people committed suicide during transition or how some people had to transition more than once before they were successful. I set out to follow the SOC and hire a therapist to maximize my ability to be successful the first time. I carefully planned things out, took my time and succeeded. Transition is NOT a race. Although we may wish we could snap out fingers and be our true selves tomorrow, reality just doesn't work that way. Transition is also not just a physical undertaking, it is also a transformative mental change as well.

Also the SOC are not some monolithic monument. They have been revised 6 times, 6 times!!! The current version (v6 2001) are very patient friendly. Just about all the nastiness of previous versions are gone. There is also plenty of built-in flexibility now. For adults there are only two fixed rules (3 month evaluation prior to HRT and 1 year RLT w/letters). And both of those are flexible depending on your therapist.

The SOC is not the problem.

The only problem today is how some therapists and some countries interpret them. So if your therapist is being a jerk, get a new one. But if you're in one of those countries that impose there own additional rules there isn't much you can do.

The SOC are very necessary. For those who don't think so I have a useful quote:

"A physician who treats himself has a fool for a patient."

disclaimer: I am a medical professional (not a doctor)

They protect people, sure. My question is why are they not needed in the case of other life-changing things? Women and men, intersex or not, who have to take lifelong hormonal therapy. They're sometimes not even consulted, the hormones imposed on them (with the proposal that it will make 'real men' or 'real women' out of them, regardless of their own thought on the matter), at dosages far riskier than what trans people are subjected to sometimes, and no one thinks the doctors are going to be sued, it seems.

While I think guidelines should exist (if only for clueless therapists and impulsive people), I think the way they exist now is stupid. Even the 6th revision, yes. The 3 months hormones and 1 year full-time requirements were invented out of thin air. It might work for some people, but that's random chance. They didn't base those amounts of time on studies or anything of empirical value.

I doubt I'll be able to get two letters from therapists who both know how to write the letter so the surgeon will green light it, and who are willing to write such a letter. Because most of those are in the private, which isn't covered. And I can't afford 6 months worth of 100$/hour meetings once a week. That's 2400$. Not counting therapist #2.

So both because of this limitation, and because I do not view the current form of the SoCs as valuable, I will go to Thailand where they waive the two letter requirements in exchange of other less stringent requirements (being 6 months with new name and full-time, proof of taking hormones), even if it means paying the amount in full from my own pocket.

I've been declared sane and without comorbidity by a psychologist and a psychiatrist, but neither knew how to or would write letters (they thought they did not have the right to). I'm not sure what else they want to know besides being insured of my sanity and no-regret.

Getting hormones initially was hell. I went to a psychiatrist, wanting to follow the SoC way, and he refused to help me. I had to go get hormones from a generalist who did not require a diagnosis. It was that or suicide. I went to the Montreal official gender clinic later on and was refused on grounds of believing in physical causes of GID, as well as reincarnation. That qualified me as deluded apparently. Then I got my last psychiatrist, who gave me a diagnosis of GID and who said I was otherwise "boring" because I was perfectly sane, we had nothing to work on. She saw no reason to keep seeing me. I got the diagnosis 2 years after starting hormones though.

This might seem foolish for some, but I knew well before I went to the first psychiatrist that it was for me. And now, three years full-time (and hormones) later, I know just as well that it was the right choice. I wasn't confused or unsure, but doctors were as reluctant to treat me as if I told them I had AIDS and an open bleeding wound.

[Guest julia_d]

Maybe I can blow some things out of the water with what those doctors have said..

If things had gone to plan I would have a sister 12 years older than me, but she was stillborn

My mother was exposed to high pesticide levels in the 50's and 60's .. which is why my gender therapist is interested in my case. There is evidence of pesticides causing genetic damage. (or re-affirmation I prefer to think) The high predominance of xx-xy humans and various intersex in animals in south east asia being linked to agent orange for instance (it's used as a synthetic estrogen believe it or not.. comes in pills)

Reincarnation and physical causality in one box XD

I have been a girl since my earliest memories.. I even went to school as a girl sometimes. I have pictures to prove it!

You know who you are.. carry on *hugs*