SRS on Demand?

[Drea]

Ive seen different points expressed on subject of the requirements to have SRS. Thought this might be an intersting poss/discussion.

[Guest Jo-88]

I think that the therapy requirements are absolutely necessary but the mandatory 1 year real life test should not be mandatory... although I do understand its reasoning. Im not going to say what is on here because that would be irresponsible but there already is a loop hole around the real life test requirement, and I suspect that it has been used frequently.

[Guest Kelly-087]

I think it's one thing to have looser requirements on HRT(Which is good, for the most part.). But no reqs for SRS? I think that's a horrible idea. It's a major surgery that isn't reverse-able (While HRT in most aspects is.)

I don't see how HRT and RLT are a terrible thing for this very major surgery. Just the ammount of time one needs to start the hormones and go full time, gives them the time to start understanding how their life is going to change.

[Guest Jo-88]

I don't believe HRT is an official requirement considering in many cases patients cannot do HRT (for numerous health reasons) but still end up transitioning. I think by far the biggest concern is counseling with at least two therapists for an extended period of time... that should stay a requirement without a doubt.

[Guest Robin Winter]

I think the current requirements are pretty good, though I've often thought maybe the rlt requirement should be shortened a little.

[Guest mistygirl7]

I think that hrt should not be controlled by therapist agreement but still be required to at least talk to a therapist before making a decision on whether or not to proceed with hrt and surgery but RLT should be shortened to at least a year before surgery.

[Charlize]

I don't have any problem with the present requirements. It takes time but it is most likely a good thing. I think we need the time to find ourselves and the certainty of our paths. Therapy also helps us know what can and can not change with both hrt and surgery.

I think acceptance and knowledge of these limitations makes our decision better in the long run.

Hugs,

Charlie

[Guest]

When I was looking at the long road through RLT, getting to SRS, I only hoped that I could get there before I died. Seriously. I don't think I would have made an immature decision 2 years ago - the only difference now is 2 years. I'm not unhappy about the last year and a half of RLT/full time, but still think it would have been even more fulfilling had I started the time with SRS instead of ending it.

It does come down to numbers, doesn't it? Would the percentage of unhappy postops increase if there was no RLT requirement? In many ways, I really doubt it.

But, if all requirements were eliminated, I do think there would be trouble. We have seen people here who have incomplete understanding, who need to work out their real needs before having irreversible surgery.

So - it seems necessary to have some standards of care but perhaps a year of RLT shouldn't be the gold standard for a person's ability to have a good outcome following SRS. But what standard should replace it?

After all of my above arguements for eliminating RLT, I for one would have been unprepared and would have had a horribly stressful time with SRS two years ago: Transition was a difficult enough process, the maturation of which took a good 8 months - it would have been additionally difficult as a recovering postop. Perhaps it's because my surgery is only a few months away that I'm more relaxed now. I think I'll live long enough!

Anyway, thank you Drea for provoking a lot of discussion! I look forward to everyone else's thoughts...

Love, Megan

[Paula ult]

Having been through the whole process and following the SOC, i think the current standards for srs are fine, i don't feel 1 year RLT before getting the letters for srs is unreasonable, after all srs is major life altering major surgery, RLT gives the person time to make sure this is what they really need to do and to grow and begin to socialize, i lived full time 2 years before getting srs, and i am glad i did.

Paula

[Guest LizMarie]

I think the current requirements are "reasonable" but I would never want them to be set in stone. For most of us, the requirements work and make sense but I can see cases where the therapists and the surgeon involved agree that it should be done under some different schedule.

[Guest Jo-88]

Totally agree Liz... every rule has an exception (well almost anyway)

[JenniferB]

I'm not going to have SRS until many months after RLT, but I would say that I've felt very comfortable living full time after about six months (8 months now). I'm sure the rest of the RLT won't make much of a difference. I do think you should have a RLT for an indeterminate length of time, it's just wonder if one needs to wait one year. But again, it's not really that long.

Jenny

[VickySGV]

Unless there is a major influx of GCS surgeons in the next year or two, the RLT for a year will be moot, since it will take nearly a year to get on the surgeon's "to do list". The surgeon does not need the lettter until the last few weeks before the surgery, so deposit what you need before you get the letter.

[Guest KimberlyF]

Unless there is a major influx of GCS surgeons in the next year or two, the RLT for a year will be moot, since it will take nearly a year to get on the surgeon's "to do list". The surgeon does not need the lettter until the last few weeks before the surgery, so deposit what you need before you get the letter.

What does one have to do with the other? You can book a surgery a year out, which means you must be FT to book it?

Anyway back to the OP. Shortly after joining LP I predicted Informed Consent was the future of HRT. Look where we are.

Ten years from now I figure surgery will be on demand. How can it be prevented when its not a mental condition so one doesn't need therapy and it can be life threatening. Every hoop could be costing countless lives.

In the future these days will be looked at like the dark ages. They'll be talked about like we talk of therapists requiring patients to go FT prior to starting HRT. How barbaric!!!

[Guest Leah1026]

In the future these days will be looked at like the dark ages. They'll be talked about like we talk of therapists requiring patients to go FT prior to starting HRT. How barbaric!!!

The Dark Ages? How about before we even had the SOC? Or better yet, before Dr Benjamin started treating people.

You think things are bad now? You have no idea how much more difficult things were just in the recent past. And just over 60 years ago there was no treatment period. THAT was barbaric.

As someone that's been through the system, I think it works fine the way it is. The one thing I would change is having the insurance industry do the right thing and cover transitional medical care.

[JJ]

Unfortunately this particular birth defect has heavy psychological effects which need to be addressed . We have all seen too many here who rushed the whole process only to crash and burn.

There are instances where surgeons who do facial reconstructions require counseling prior to surgery and where surgeons who restore sight to someone long blind or born blind also require counseling prior to surgery . Because those situations have been shown to have devastating rather than positive outcomes when the patient is not prepared to face the psychological repercussions of such a drastic change. People have been known to blind themselves again or completely withdraw from the world or have total breakdowns because they could not handle the sudden changes in their world. This condition requires it too in my opinion.

If SRS ever becomes on demand I expect it will cost far more lives than anything in the current system and would eventually set us back a long way because of the repercussions and mental damage to those not really prepared for what they face. Sadly it is too often those who need to go slowest who wish to rush fastest as well.

Johnny

[Cyndee]

It appears I voted in the majority and think the current requirements are just fine. I like the fact that my therapist is flexible and takes into account my life's unique circumstances, it's a very individual thing, I want to get through my RLT, it's a personal challenge. I take it seriously.

Cynthia -

[Guest (Lightsider)]

I totally think the current standards is the best route. If this surgery was on demand it could backfire in a big way over regret. If some one is going to rush into this and I was the surgeon I would turn that person away. That to me is a red flag. Detransition does happen. People do change their mind later.

[Guest KimberlyF]

In the future these days will be looked at like the dark ages. They'll be talked about like we talk of therapists requiring patients to go FT prior to starting HRT. How barbaric!!!

The Dark Ages? How about before we even had the SOC? Or better yet, before Dr Benjamin started treating people.

You think things are bad now? You have no idea how much more difficult things were just in the recent past. And just over 60 years ago there was no treatment period. THAT was barbaric.

As someone that's been through the system, I think it works fine the way it is. The one thing I would change is having the insurance industry do the right thing and cover transitional medical care.

that part of my post was sarcasm.

But when surgery is on demand as I predict it will be, I also figure things will break down with those who have gone through all of the current steps feeling it's a bad move and those who haven't feeling how awesome the change is.

Most on this board recommend talking to a therapist as one of the first steps in transitioning and yet somehow a tiny minority of activists in the 'Trans community' have been working with the people in the SOC to make therapy no longer a requirement. Victory is ours!!! That last line was sarcasm.

[Guest KarenLyn]

I can understand the sarcasm. There will always be those who will turn around and sue the doctors in spite of having been informed that it's a one way deal and they had better be sure. The other thing will be the waiting lists for surgery will get a lot longer.

[Guest KimberlyF]

The longer waiting lists are coming anyway. With certain municipalities starting to cover the cost and more companies paying for te coverage, while the small pool of doctors doesn't get bigger, how else can it go?

[Drea]

It seems to me that waiting lists have gotten shorter and that earlier openings are even more common than the past.

Despite there being more surgeries, the number of active surgeons has increased.

What I do think will make waiting lists longer will be nationalized health care as countries with natiionalized healthcare have extra waits.

A bit of historical commentary.

In the early 2000s Thialand started to grow in popularity for SRS for trans folk in the US.. The relativly low cost was one factor because even after factoring in airfare it was less expensive than surgeons in the US. Later on quality was quoted as a reason with some surgeons while in the earlier days the quality was unknown.

Another factor was that standards were far looser for getting SRS in Thialand. In some cases there was nothing more required than a perfunctory psych eval performed after the client got there. I also heard stories of "humanitarian exceptions" to requirements being given. So I guess SOC standards that westerners were required to adhere to were considered inhumane? Anyway was kind of a little soken about reason to go to Thialand (lower standads) but I know of a number of folks that admitted such.

A few years ago Thialand decided to crack down on this relitivly low requirements for SRS despite the money it was bringing into the country. They passed laws requiring certain standards. I doubt this just occurred for some abstract reason. I am willing to bet that the low standards had resulted in problems. I also noted that we went into a period where the interest in going to Thialand lessened in favor for more domestic surgeons. Still some remained interested in Thialand for quality or cost.

It does however seem that requirements in Thialand are less than typical domestic US surgeons. Maybe finding some loopholes. They do require referral letters now, but things like RLT/RLE and a second letter some aren't so firm about.

From what I seen, there are a broader range of folks who go for SRS now than in the past as the definitions of what it is to be transsexual or transgendered have expanded. Standards have gotten looser and many of the therapists, particularly gender therapists aren't requiring the same number of visits as in the past.

In the past when someone had gotten referral letters for SRS there were things about those individuals that I had come to expect. They always tended to seem well grounded in their identity. As a group they tended to be pretty stable, to not seek external validation from others, not engage in self justification. All things I tended to attribue to having been through a great deal as well as time in therapy.

This is something I have seen change. While there are still plenty who are going for SRS who are very much as I describe. There are those others who seem to stand out in the way they are unstable. I am not sure that is that I would call a positive trend.

[KathrynJulia]

I like the current standards just the way they are. Good, intelligent people have researched this subject quite well and have reached these conclusions as the safest way for us to transition. I've waited half a century to transition. I've lived through hell and back. I've had a child psychologist back in 1961 detail all the terms for us back then. I was made to be ashamed and traumatized.

I have stayed in the closet only venturing out ocassionally. I've raised a family and I've reached the point where I am ready. We go through a lot of hoops. Insurance policies need changing, not the standards, and cover surgery after a person has followed the prescribed standards and desires it.

The standards give us legitamacy and acceptance is increasing because of those standards. I've lived in the real Dark Ages. People are much more understanding today than they were 40 years ago. Kathryn

[~Nova~]

I think that the therapy requirements are absolutely necessary but the mandatory 1 year real life test should not be mandatory... although I do understand its reasoning. Im not going to say what is on here because that would be irresponsible but there already is a loop hole around the real life test requirement, and I suspect that it has been used frequently.

One year is not mandatory. I was RLT for 6mths. It's up to the therapist ans surgeon.

Saying that, I think it should be mandatory. To say I was ready would be a gross lie.

[Drea]

Yes the loop hole is common. In fact the docs seem to not worry about the 1 year as long as one has done the key things that lead up starting RLT. 1 year is very minimal.

Since SRS (Not counting FTM top surgery) doesn't affect passing, there is great fallacy in the idea that RLT is an unfair burden. If one is intending a social role transition wouldn't one have to do all the same things anyway? Nobody is going to know what is between your legs. So the only way in which it could be a burden is if one never plans to go full time and doesn't plan a social role transition.