Real Life Experience Prior To Surgery...

[Guest Zenda]

Kia Ora,

Just a quick poll [yes I’m becoming somewhat addicted to doing polls] on what the feelings are amongst trans-people regarding the compulsory RLE that most countries have in place prior to one having Gender Affirming Surgery[G.A.S] and in some cases prior to obtaining HRT…

I know that some trans-people don't give too much importance on having a R.L.E period prior to having G.A.S...They have their reasons, but I find it hard to understand why any trans-person would wish to bypass the RLE

For me personally I didn’t really go through a RLE, has mentioned in past posts…Unlike many here, affirming my gender in public, was not part of a prerequisite for G.A.S … G.A.S for me was just a bonus-not the goal...

Those for whom G.A.S is the goal, a RLE period is I feel a must and the longer the better…Requirement for those who travel to Thailand for GAS is on average 6 months RLE -most highly sort Thai Surgeons when dealing with Western clients tend to follow the standard of care recommendation regarding psyche assessment reports but are somewhat relax with the RLE period of their trans patient…

For government funded surgery in Aotearoa [NZ] the RLE period was 2 years…I’ve since heard they have now changed it to one year…I think in the UK it’s still two years…

One has to bear in mind that G.A.S is for the most part irreversible…One can never ‘physically’ go back to looking & feeling 100% like they were before…

http://ai.eecs.umich.edu/people/conway/TS/Warning.html

Some young trans-people have never really interacted in main stream society as their ‘birth sex’…They have always rebelled against the idea that they must live and behave in the manner society deems as appropriate for what’s between their legs…Like a duck to water they tend to take to the RLE-RLE for them is ‘water off a duck back’…

What RLE period ‘if any’ do you feel is necessary prior to having G.A.S ?

Metta Jendar

[Guest Christy.dancer]

OK, I'm a little selfish here -- I haven't even discussed timing with my therapist yet, but we're pretty sure that the EARLIEST I could do surgery is summer-after-next, due to skule, etc. I'm aiming for that. Anyway, I voted two years, because of that. Would I do surgery TOMORROW if I could? Prolly not. Seriously... this is a huge decision, and I'm fortunately at a point in my life when I can take some time and let it sink in.

[Guest michelle.butterfly]

Well I have a hard time answering your poll because it doesn't seem to me to have enough choices...

I think my answer is "it depends" and "it depends on what you mean."

it depends

It depends on the person; if they were always very much themselves but just hadn't explicitly stated, should that not count as real-life experience? What if you couldn't be out at work but were everywhere else for many years while you saved money? What about someone who had been on hormones for years but had nonetheless continued in their original gender role some of the time?

In my opinion it's too complex of a situation to pick a one-size-fits-all amount of time.

it depends on what you mean

Do you mean this as in "how long is advisable" or "how long should be forced upon someone"? Because of the monopoly of licensure by the state, there are generally few, if any, alternatives to the prevailing authority's rules. If someone violates those rules, they are subject to losing their license, and therefore it becomes an opinion forced upon people by a single organization using the force of the government.

I believe that were there an open market on licensing, many alternative sets of ethical rules could be formed, and you would be free to seek out a psychiatrist/surgeon/etc. that most closely fit your needs and beliefs, perhaps one who could take into account situations mentioned above in the "it depends" section.

So, if you mean "how long should be forced upon someone," my answer is that you shouldn't try to force others to conform to your particular beliefs.

Now, if you mean how long is advisable, I would say it depends (hee hee) but probably a minimum of somewhere between three months and a year, depending on the degree to which the individual had already assumed the desired gender role.

How's *that* for an answer.

Michelle

[Guest Kelly Ann]

as always great question Jendar. I would have to seriously transition...erm, okay...so I'm probably there I just am not certain ot is REALLY right for me. I would HAVE to have at minimum 2 years to even think of such a drastic course for myself. For others it's definately different...there should be some sort of transitional time to become comfortable and functional before something so drastic is undertaken. What if it is wrong for a person...OOPS!! YIKES and now there's another issue to overcome...slow and easy is best for me so I have the justifiable time for true deliberation within myself...sometime what you really want may not be the best for you either which is another good reason for having clarity on such an important decision. A simple coin toss just wouldn't do Kelly Ann

[Guest Zenda]

Well I have a hard time answering your poll because it doesn't seem to me to have enough choices...

Kia Ora Michelle,

I’m afraid I don’t quite have a 100% solution to the conundrum that you have presented, however I will try and answer some of your questions as best as I can….

I think my answer is "it depends" and "it depends on what you mean."

it depends

It depends on the person; if they were always very much themselves but just hadn't explicitly stated, should that not count as real-life experience?No…How can a therapist determine that a person as 'always' associated with their preferred gender-What’s to stop a ‘deluded’ person from lying? What if you couldn't be out at work but were everywhere else for many years while you saved money? What would be the reason as to why one couldn’t come out at work prior to having surgery? ‘Fear’ of being sacked? If that was the case, how is that person going to cope in main stream society-if they are constantly fearful of rejection?…by their closeted actions this would indicate they weren’t quite ready to under take such a major life changing thing such as major surgery… What about someone who had been on hormones for years but had nonetheless continued in their original gender role some of the time? Doesn’t that indicate that this person is not fully comfortable presenting in society as a whole? Their closet door maybe wide open, but part of ‘self’ is still hanging inside-which can’t be healthy…

In my opinion it's too complex of a situation to pick a one-size-fits-all amount of time.

it depends on what you mean

Do you mean this as in "how long is advisable" or "how long should be forced upon someone"?Why do you think RLE is part of the Standards- if not purely for safety reasons? That is, out of concern for the patient’s ‘long term’ wellbeing…so a little force is necessary don't you think?? Because of the monopoly of licensure by the state, there are generally few, if any, alternatives to the prevailing authority's rules. If someone violates those rules, they are subject to losing their license, and therefore it becomes an opinion forced upon people by a single organization using the force of the government.

I believe that were there an open market on licensing, many alternative sets of ethical rules could be formed, and you would be free to seek out a psychiatrist/surgeon/etc. that most closely fit your needs and beliefs, perhaps one who could take into account situations mentioned above in the "it depends" section. Wouldn't that make the process even more complex than it already is???

So, if you mean "how long should be forced upon someone," my answer is that you shouldn't try to force others to conform to your particular beliefs. And let anarchy rule without any kind of safety net - how humane/civilised would that be???

Now, if you mean how long is advisable, I would say it depends (hee hee) but probably a minimum of somewhere between three months and a year, depending on the degree to which the individual had already assumed the desired gender role.And how does one measure that degree??? “Hey doc I assumed the ‘desired gender role’[in my mind] when I left the womb - does that count???” However on a more serious note, for young trans-people who have never tried to conform to the socially accepted gender norm there should be some leeway…

How's *that* for an answer. And how's that for a response???

Michelle

Please bear in mind that these are my personal opinions and by stating them it was not my intention to offence any reader

Michelle,

I’m not too familiar with the American legal system ‘laws and regulations’…

I realise that in order for some to participate in the RLE, there must be some leeway by the government/state involved enabling for example, a provision for a temporary document covering ‘legal name change’ and the like, so as to make life a little easier when having to do the required RLE time …

Here in Aotearoa, there’s no male/female stated on our driving licences so if you look like a female and have change your name by deed poll then the photo on your licence and name match up, however of one is pulled over by the police and they do a computer check, your birth sex will show up…

It’s true that “One size doesn’t always fit all!” I can see that by the conundrum that you presented… but in certain situations such has having major life transforming surgery…even with all the pit falls, I still personally feel that ‘one’ standard size 'RLE' is the best and safest option…And the longer the better, especially for late transitioners whose true psycho-gender identity has lived in the closet for many years gathering dust so to speak…It’s a different world outside the closet…Some might say it’s a jungle out there-survival of the fittest…

RLE is like checking your parachute for holes before you jump…

Metta Jendar

[Guest Nelly]

Hi,

I woudl choose yes but without saying any special duration.

Surgery is allways a big step with no return back option. So you have to think good enough about it. If you take the RLE you can see if you are happy as a women with some extras. As I understand, with HRT the thing down their will shrink and has less self movements. So tucking will be more easy. If you find out during RLE that this is just fine, I would not choose the surgery. But if you find out that this is not enough, e.g. you want go out in tiny pants and tucking is not possible, or you want to have sex as a female person than you can think about surgery and if surgery can solve your problem.

For me changin into a women shape is allways together with some disscomfort. To reduce the spare tire I need a corset. To reduce the thing down their I need to tuck. This is all not comfortable over time and than I get the idea that with HRT it would be better because the tire disapear and think got less down their. But I also have the wish to have sex as a women. So surgery would be the solution. But on the other hand with HRT the libido will reduce and maybe I loss the wish to have sex. So future will see and for me I will try to have some time as a woman with some extras to see if I am happy with that.

If I would be a therapist and I would get a person who want to have surgery very fast, I would slow her down to think about it.

Greetings

Nelly

[Guest leo]

the reason fre RLT is to see if you really mean it and are serious and that you dont make a mistake and do surgery like the next day and regret it

also kinda like a taster of the other life

[Guest N. Jane]

Well things have changed a LOT in the last 35 years so my thoughts probably don't count for much but making such a major change in one's life (is there a bigger one?) without some idea of what you are getting into would be foolish. Were I on the therapist's or doctor's side of the issue, I would insist on at least six months to a year of full time, 24/7 or equivalent.

I live part time through out my teens, any time I could get away from home for a weekend (or when I got thrown out, or when I walked out) and it really helped me get a sense of who I was (in the role I wanted to live). Of course, as a teen, it was excellent timing as it helped me learn a lot of the things that young girls learn as they are growing up. It gave me some sense of what to expect if transition and SRS ever became possible (which it eventually did).

[Guest Elizabeth K]

Huuumph

I am a typical citizen and think everyone should adhere to the laws, whatever those laws may be. WAIT, they apply to me? Oh hold on a minute....

Yes RLE is needed. "RLE is like checking your parachute for holes before you jump… " PERFECT!

Everyone needs to be sure and the [pick one] years requirement is for your own safety!

Wait, it applies to me? I want my SRS TOMORROW! Yikes! How unfair!

Yes, if I had my letters and if I had the money, I would be scheduling for SRS ASAP and PDQ (too many letters - grin)

I tell my therapist I am gonna be 62 years old in June, and will NEVER finish out my transitioning before I die. She just grins and says,"I am not easy!" I know if I try to strangle her it will probably set me back a bit... hummmmm.

So does that address the topic?

Lizzy

[Guest michelle.butterfly]

Hello Jendar! (big hugs)

I'm afraid I have some invalid characters in here so we'll see if it's still readable...

Well I have a hard time answering your poll because it doesn't seem to me to have enough choices...

Kia Ora Michelle,

Im afraid I dont quite have a 100% solution to the conundrum that you have presented, however I will try and answer some of your questions as best as I can.

I think my answer is "it depends" and "it depends on what you mean."

it depends

It depends on the person; if they were always very much themselves but just hadn't explicitly stated, should that not count as real-life experience?NoHow can a therapist determine that a person as 'always' associated with their preferred gender-Whats to stop a deluded person from lying? Nothing, I do not believe in saving people from themselves, if you are thinking clearly, and you make a reckless decision (lying to your therapist), then you will suffer the consequences. If you are not thinking clearly, then your therapist should be able to determine that from the rest of his/her interaction with you and stop you anyway. What if you couldn't be out at work but were everywhere else for many years while you saved money? What would be the reason as to why one couldnt come out at work prior to having surgery? Fear of being sacked? If that was the case, how is that person going to cope in main stream society-if they are constantly fearful of rejection?by their closeted actions this would indicate they werent quite ready to under take such a major life changing thing such as major surgeryOr, rather than fear, perhaps someone might know they are in the sweetest job ever, making more money than they will ever be able to make again, and know they can save up enough money to take care of surgery, meds, etc. and to provide a nest egg afterward. My point as it will always be is that it's a decision that should be left to the therapist and the patient, since they are the only ones who are in a position to truly know whether that decision was out of fear or an educated trade-off. What about someone who had been on hormones for years but had nonetheless continued in their original gender role some of the time? Doesnt that indicate that this person is not fully comfortable presenting in society as a whole? Their closet door maybe wide open, but part of self is still hanging inside-which cant be healthy Maybe her mother was sufffering from senile dementia and reacted violently whenever the subject was brought up, to the point that it was a hazard to her health. So, she decides out of compassion that since she is caring for her mother in the little time she has (when she's not working hard to make money for surgery because she gave up this sweet job because she just had to come out somewhere) that she will be in her original gender role at night in order to spare her mother pain. See, no matter how many of these scenarios you can come up with where it would be a wrong decision, a good therapist would catch the ones who need to wait longer by their ethical rules, but would be able to also do the right thing for the people that are in extraordinary circumstances that should be excepted. Remember I'm never arguing that there shouldn't be ethical standards or that you should choose an unethical or incompetent therapist. I'm only saying that there should not be one set of standards, decided by a governmental body or a body given monopoly power by the government, that is imposed upon all therapists and therefore all patients. Freedom of choice, hon, that's all I'm about.

In my opinion it's too complex of a situation to pick a one-size-fits-all amount of time.

it depends on what you mean

Do you mean this as in "how long is advisable" or "how long should be forced upon someone"? Why do you think RLE is part of the Standards- if not purely for safety reasons? That is, out of concern for the patients long term wellbeingso a little force is necessary don't you think?? No, because I personally believe it is wrong to use force against another individual except in cases of self-defense. Because of the monopoly of licensure by the state, there are generally few, if any, alternatives to the prevailing authority's rules. If someone violates those rules, they are subject to losing their license, and therefore it becomes an opinion forced upon people by a single organization using the force of the government.

I believe that were there an open market on licensing, many alternative sets of ethical rules could be formed, and you would be free to seek out a psychiatrist/surgeon/etc. that most closely fit your needs and beliefs, perhaps one who could take into account situations mentioned above in the "it depends" section. Wouldn't that make the process even more complex than it already is??? Perhaps, but sometimes a little extra complexity provides benefits; in this case you would probably compare statistics on various rules such as life satisfaction, regret, etc. and decide based on some criteria that *you* get to decide which one is right for you. Eventually if one or another is particularly bad it will stop being chosen because the competing systems would point out the failures of the bad ones.

So, if you mean "how long should be forced upon someone," my answer is that you shouldn't try to force others to conform to your particular beliefs. And let anarchy rule without any kind of safety net - how humane/civilised would that be??? Well, actually I believe that something very close to Anarchy, Minarchy, is the form of government which will actually provide the results that are desired and aimed at by failed socialist policies. I believe that the safety net to which you refer would come naturally via charity because of the massive increases in wealth generation in a truly free society. You can see this effect in the fact that the poor in western nations are better off than almost all the people in nations that have little freedom. There are effects seen and effects unseen. I recommend reading "Healing our World" available by Mary Ruwart available in a free first edition at http://www.ruwart.com to understand the type of vision I have of a truly free society. No need to roll your eyes at me. (said non-seriously and with a light heart don't take me seriously when I say stuff like that!!! Works better in person 'cause u can hear my tone of voice.)

Now, if you mean how long is advisable, I would say it depends (hee hee) but probably a minimum of somewhere between three months and a year, depending on the degree to which the individual had already assumed the desired gender role.And how does one measure that degree??? Hey doc I assumed the desired gender role[in my mind] when I left the womb - does that count??? However on a more serious note, for young trans-people who have never tried to conform to the socially accepted gender norm there should be some leewayYou would decide it the way things are decided now, with the best judgement of the therapist when dealing with a particular patient, taking their particular situation into account. I think you miss the point that I don't think there should be a "standard measure". When you do so, you end up missing some people on the edges of the bell curve, no matter what you choose. 2 years is probably not long enough for some and too long for others. The proper people to make such a decision are the therapist and the patient.

How's *that* for an answer. And how's that for a response???

Michelle

Please bear in mind that these are my personal opinions and by stating them it was not my intention to offence any reader

Michelle,

I’m not too familiar with the American legal system ‘laws and regulations’…

I realise that in order for some to participate in the RLE, there must be some leeway by the government/state involved enabling for example, a provision for a temporary document covering ‘legal name change’ and the like, so as to make life a little easier when having to do the required RLE time …

Here in Aotearoa, there’s no male/female stated on our driving licences so if you look like a female and have change your name by deed poll then the photo on your licence and name match up, however of one is pulled over by the police and they do a computer check, your birth sex will show up…

It’s true that “One size doesn’t always fit all!” I can see that by the conundrum that you presented… but in certain situations such has having major life transforming surgery…even with all the pit falls, I still personally feel that ‘one’ standard size 'RLE' is the best and safest option…And the longer the better, especially for late transitioners whose true psycho-gender identity has lived in the closet for many years gathering dust so to speak…It’s a different world outside the closet…Some might say it’s a jungle out there-survival of the fittest… Ok, well, but you said it best: you *personally* feel that one standard RLE is the best and safest option. Also I would like to say that the "safest" option for something is not always best; for instance a 5 mile an hour speed limit rigidly enforced would prevent almost all fatal accidents, but again you have the seen and then the unseen. You are missing the people that are hurt by the standards, and what right do you have to hurt any individual just because you want to protect others from themselves?

RLE is like checking your parachute for holes before you jump…

And I'm with you more than you think, I highly recommend anyone considering SRS check the parachute for holes, proper tying, proper folding and proper packing before making the jump. But I'm recommending it, not standing behind them with a gun stopping them from leaving to go jump without having done so.

One Final comment, Jendar, I personally believe that people and their therapists should make very sure that this is a right decision for them. I was never disagreeing about that. I just feel it's not my place to tell someone else how they *have* to do it, I'm not their mom, I'm just their friend. :shrug: I think we mostly agree here the disagreement is over the proper role of government involvement in the decisions rather than the proper course of action in any particular case. Much love to you Jendar, you obviously care very much and I do not mean to seem as if I am being confrontational.

Metta Jendar

[Guest julia_d]

Interesting. Where would somebody who was tested for 2 years like this stand after 8 years.

I think I have found a deeper understanding of what it is all about. I don't believe it is about helping the "patient".. I'm inclined to feel it is more a test of determination.. because they have no other real way to check the genuine from the fake.

All these years later I have trouble remembering what that time was like.. the worry about somehow failing and being kicked out of the program (they dropped me due to THEIR admin error.. grrrrrrr) The trying to show them what I thought they wanted to see. All the soul seeking and finding of yourself.. I never lost me through my life.. all I needed to do was change the name on some documents... but because of their ridiculous test I probably made my life much harder than it needed to be for those few years.

Now this might be rather contentious.. but I think the RLT isn't about the transperson at all.. I think it's about the liability of the medical people. They have the copout "you tricked us for 2 years.. so you aren't happy now.. tough.. live with it.. it's your fault not ours" which they can use in cases where the person isn't happy with the outcome, or it isn't what they really wanted. There are people like that around, but by making us all jump through these hoops they fail.. because with these strict kind of tests anybody who is determined can and will trick them. I feel their eyes on me accusing "you aren't wearing a skirt" .. I challenge them to go out in the rough city and find me any other early 40's woman alone on the streets wearing a skirt. I looked.. and I didn't see one... apart from women who are forced to wear them as part of a discriminatory dress code at work.

Having in the course of my campaigns and travels I have met a lot of transwomen.. and lets be honest.. if it was about passing I knock spots off most of them.. so it's not about that.

2 years.. so the medical people can cover their backs.. but I think there should be some discretion used by the medical people. Somebody like me who has expressed this knowledge of who I am and what I should have since my early teens should be able to just tell them to get on with it. It's not like it's something I dreamed up overnight.. and my medical records prove it.

[Guest Zenda]

Hello Jendar! (big hugs)

I'm afraid I have some invalid characters in here so we'll see if it's still readable...

Please bear in mind that these are my personal opinions and by stating them it was not my intention to offence any reader

Michelle,

I’m not too familiar with the American legal system ‘laws and regulations’…

I realise that in order for some to participate in the RLE, there must be some leeway by the government/state involved enabling for example, a provision for a temporary document covering ‘legal name change’ and the like, so as to make life a little easier when having to do the required RLE time …

Here in Aotearoa, there’s no male/female stated on our driving licences so if you look like a female and have change your name by deed poll then the photo on your licence and name match up, however of one is pulled over by the police and they do a computer check, your birth sex will show up…

It’s true that “One size doesn’t always fit all!” I can see that by the conundrum that you presented… but in certain situations such has having major life transforming surgery…even with all the pit falls, I still personally feel that ‘one’ standard size 'RLE' is the best and safest option…And the longer the better, especially for late transitioners whose true psycho-gender identity has lived in the closet for many years gathering dust so to speak…It’s a different world outside the closet…Some might say it’s a jungle out there-survival of the fittest… Ok, well, but you said it best: you *personally* feel that one standard RLE is the best and safest option. Also I would like to say that the "safest" option for something is not always best; for instance a 5 mile an hour speed limit rigidly enforced would prevent almost all fatal accidents, but again you have the seen and then the unseen. You are missing the people that are hurt by the standards, and what right do you have to hurt any individual just because you want to protect others from themselves?

RLE is like checking your parachute for holes before you jump…

And I'm with you more than you think, I highly recommend anyone considering SRS check the parachute for holes, proper tying, proper folding and proper packing before making the jump. But I'm recommending it, not standing behind them with a gun stopping them from leaving to go jump without having done so.

One Final comment, Jendar, I personally believe that people and their therapists should make very sure that this is a right decision for them. I was never disagreeing about that. I just feel it's not my place to tell someone else how they *have* to do it, I'm not their mom, I'm just their friend. :shrug: I think we mostly agree here the disagreement is over the proper role of government involvement in the decisions rather than the proper course of action in any particular case. Much love to you Jendar, you obviously care very much and I do not mean to seem as if I am being confrontational.

Metta Jendar

Kia Ora Michelle,

We can both agree that a RLE is an important part of transition prior to surgery, plus we can also agree to disagree on the time frame...

I must apologise, it’s occurred to me I’ve been thinking more on the lines of ‘government funding’ when it comes to the RLE…I now can see that for the individual whose going to pay out of their own pockets, there are quite few hoops to jump through and being forced to under go a RLE of any period of time, is in a sense a violation of ones human rights-my money, my life etc, etc…

What I should be saying is check your parachute, then check it again and again for 3 months or 6 months or a year or two, when you find it’s flawless-that is, it will safely bring you down to earth-jump and enjoy the ride…If you don’t ‘check’ your parachute first, you could live to regret it…

You have some interesting points Michelle...But will this cunundrum ever be solved-finding a way to please all involved??? Different strokes for different folks-but there are thousands of different folks with different needs... For me the RLE time frame is irrelevant...However this doesn't stop me from being deeply concerned for those who might try and rush through things...

I'm unsure of your personal status Michelle, but I do hope that wherever you're at, life is treating you well...

Metta Jendar

[Sally]

I would like to interject a bit of cold, clinical cynicism.

The real reason for the RLT, no matter what they may say (Who are 'they'?) is not really to protect us from us, but rather the Doctors from us.

Michelle mentioned the case of someone rushing into the surgery and not being happy afterward is the exact scenario that this is designed for, because who do unhappy people blame for a surgery that they probably should never have had?

The Doctor, the hospital, the therapist, the therapist's Dog Walker, anyone who has ever said the word transsexual except themselves.

So what do they do about it, well here in America, the good old US of A where the A stands for Attorney - they sue!

Who do they Sue?

The Doctor, the hospital, the therapist, the therapist's Dog Walker, anyone who has ever said the word transsexual except themselves.

These people are protected to a great degree if all of the Standards of Care have been followed to the letter.

SRS is already one of the higher priced surgeries among all of the delicate and specialized surgeries because of the Insurance Companies charging incredibly high Malpractice policies for those Doctors, Oh, hurray for the red white a greedy!

Love ya,

Sally

[Guest michelle.butterfly]

Kia Ora Michelle,

We can both agree that a RLE is an important part of transition prior to surgery, plus we can also agree to disagree on the time frame...

Agreed.

I must apologise, it’s occurred to me I’ve been thinking more on the lines of ‘government funding’ when it comes to the RLE…I now can see that for the individual whose going to pay out of their own pockets, there are quite few hoops to jump through and being forced to under go a RLE of any period of time, is in a sense a violation of ones human rights-my money, my life etc, etc…

Oh, well, definitely no government funded transitions here in the U.S. Sorry, it was the American Cultural Assumption/New Zealandic (?) Cultural Assumpation kicking in there. http://www.c2.com/cgi/wiki?AmericanCulturalAssumption

What I should be saying is check your parachute, then check it again and again for 3 months or 6 months or a year or two, when you find it’s flawless-that is, it will safely bring you down to earth-jump and enjoy the ride…If you don’t ‘check’ your parachute first, you could live to regret it…

For me the RLE time frame is irrelevant...However this doesn't stop me from being deeply concerned for those who might try and rush through things...

No argument there; I think probably there are a lot more stories like those on Dr. Lynn Conway's site (http://ai.eecs.umich.edu/people/conway/TS/Warning.html) than we know of. It can be easy to make a mistake if things weren't considered properly and someone went too quickly!

I'm unsure of your personal status Michelle, but I do hope that wherever you're at, life is treating you well...

Thanks Jendar, life is mixed but very well compared to most I think. I hope the same for you! I will post a little more personal status on my profile page for those who are interested.

All my love,

Michelle

[Guest michelle.butterfly]

I would like to interject a bit of cold, clinical cynicism.

The real reason for the RLT, no matter what they may say (Who are 'they'?) is not really to protect us from us, but rather the Doctors from us.

I think you are right to a large extent Sally, although I know that my therapist is also genuinely concerned; I actually had a conversation about orchi today with her because my endo knows of a surgeon who will do it "outside the standards of care" and even though she knows she will not be accountable if I were to have it done and have regrets, she still tried very hard to convince me to really give it some time since it's irreversible.

I love ya back, Sally!

Michelle

[Guest michelle.butterfly]

2 years.. so the medical people can cover their backs.. but I think there should be some discretion used by the medical people. Somebody like me who has expressed this knowledge of who I am and what I should have since my early teens should be able to just tell them to get on with it. It's not like it's something I dreamed up overnight.. and my medical records prove it.

Hi Julia! (big big hugs)

You are exactly the kind of person who is hurt by the one-size-fits-all rules. This is why I believe it should be between your therapist, your surgeon, and you.

Ahh well, things are as they are and I hope you are weathering the storm ok.

Lotsa love,

Michelle

[Guest Leah1026]

The real reason for the RLT, no matter what they may say (Who are 'they'?) is not really to protect us from us, but rather the Doctors from us.

Sally, the fact is the SOC protect everyone: Surgeons, Therapists, Endocrinologists and us.

SRS is already one of the higher priced surgeries among all of the delicate and specialized surgeries because of the Insurance Companies charging incredibly high Malpractice policies for those Doctors, Oh, hurray for the red white a greedy!

That is patently FALSE. I am a medical professional and I can tell you ANY surgery that keeps you in the hospital for a week costs 2-3 times what SRS for transsexual women does. I paid $17,500 here in the USA and I consider that a bargain. YES a bargain! You don't seem to realize that we, as self-pay patients who pay cash, get a discount. It's true! Now I know many of you are hoping and praying for the day insurance coverage is available for SRS. Well I have some bad news for you: The medical insurance industry is a racket that only care about ONE thing ($$$) and it ain't about delivering the best patient care possible. Anyone in the medical field can attest to the fact that any product that has medical applications automatically costs much more. My theory is once SRS gets covered by all the major insurance companies the price will suddenly skyrocket to say.... $80,000. And guess what our "co-pay" will be? Oh... I imagine about $17,500. Call me cynical, but just watch and as they say: Follow the money.

Today's surgeons, at least the ones in the US and Canada, do NOT make a lot of money. Greed is NOT a factor among our SRS surgeons. If it was Dr Bowers would have stayed in Seattle in her lucrative OB/Gyn practice. She was even voted doctor of the year at the medical center she worked. She left that dream job to move to Colorado to help us. She has fought to keep SRS available at the current prices against terrific odds. The wonderful insurance industry that so many of us want to come to save us has *really* put the screws to her, trying to get her to quit the business by making malpractice insurance practically unattainable. This despite the fact that an SRS has never been sued in the USA. An unexpected ally is the hospital in Trinidad because without the money we bring into the hospital we help keep it afloat. Dr Bowers is also the only OB/Gyn doc for a 75 mile radius, so the community also has a vested interest as well.

So please be careful when you make accusations about how the system works and who profits. We are lucky to have what we do.

[Guest michelle.butterfly]

SToday's surgeons, at least the ones in the US and Canada, do NOT make a lot of money. Greed is NOT a factor among our SRS surgeons. If it was Dr Bowers would have stayed in Seattle in her lucrative OB/Gyn practice. She was even voted doctor of the year at the medical center she worked. She left that dream job to move to Colorado to help us. She has fought to keep SRS available at the current prices against terrific odds. The wonderful insurance industry that so many of us want to come to save us has *really* put the screws to her, trying to get her to quit the business by making malpractice insurance practically unattainable. This despite the fact that an SRS has never been sued in the USA. An unexpected ally is the hospital in Trinidad because without the money we bring into the hospital we help keep it afloat. Dr Bowers is also the only OB/Gyn doc for a 75 mile radius, so the community also has a vested interest as well.

Thanks for this Leah, I found it very informative, and nice to hear.

Michelle

[Sally]

Sally, the fact is the SOC protect everyone: Surgeons, Therapists, Endocrinologists and us.

Leah, I thought that we were particularly focusing in on the surgery (from the topic title) so I didn't mention the others, sorry if it made it look like an attack on doctors - it was not.

That is patently FALSE.

I forget sometimes that the stated price includes the hospital costs so it is right in line - My father's Knee Replacement was in the same price range when you include what the hospital and physical therpists added on to the bill so it just seems higher.

So please be careful when you make accusations about how the system works and who profits. We are lucky to have what we do.

Please read that statement again, I was in no way calling the doctors greedy - I said due to the unbelievably high cost of malpractice insurance - it is the greed of the insurance companies that cause the tremendously long waiting periods for SRS in the United States, because so few doctors learn to do it, so few hospitals allow it to be performed under their roof and insurance, it all comes back to Insurance Companies - they run up all of the costs and make health care in the United States among the highest in the world.

Dr. Bowers is incredible and an artist as well as a surgeon, I do not mind paying her fee in the least - I do not want a 'cut-rate' SRS clinic popping up in Wal-Mart, but if Mount San Rafael Hospital didn't have to pay so much for their Insurance the total cost could be even lower. Marci doesn't get that $18,500 (Currently) it includes the hospital stay and operating room staff and nurses - everything, her portion is really rather small so when that is taken into account it is a bargain. I want the insurance Companies out of control completely.

Just got a letter from my Insurance Company today and I am not a fan of them at the moment (if ever)!

I'm not being defensive here, I just want to make sure that everybody understood that I am against the Insurance Companies having so much control.

I like Doctors, some of my best friends are doctors, the Doctor that did my dad's surgery went to college with me and so did my dentist.

I don't claim any Insurance Executives or salespeople amoung my friends!

Love ya,

Sally

[Guest Zenda]

Kia Ora,

Just thought I'd add thiss to the mix...

Research in the UK re; RLE[two years, that's a requirement if one is having government funded surgery], found that around two thirds who start the 'experience' drop out, some only a few months into it...Only a third actually continue on with RLE...It's possible some of those who drop out were just 'extreme' crossdressers ie, having a feminine side but their core gender identity was not female-others may or may not have been transsexual but just couldn't cope with the stress and social pressures involved...

I've mentioned in past posts about some trans people being prescribed a very low dose of HRT not enough to produce any major changes but just enough to give them a 'peace of mind', some continued to life an androgynous life style, whilst others would still crossdress or occassionally go out in public and attend social get togethers with other trans-people...

The RLE can be a real stressful time for some, if one finds they can't cope, this does not necessarily mean they are not 'transsexual', but it is a good indicator that transitioning full time and having GAS is not the best option for them...

BTW, I believe that most if not all gender therapists that deal with trans people have a genuine concern for their clients wellbeing...A gender therapist's life is not an easy one... A counselor that I know once said "At times being the 'gate keeper' is not a pleasant job!"

Metta Jendar

[Guest Leah1026]

Kia Ora,

Just thought I'd add thiss to the mix...

Research in the UK re; RLE[two years, that's a requirement if one is having government funded surgery], found that around two thirds who start the 'experience' drop out, some only a few months into it...Only a third actually continue on with RLE...It's possible some of those who drop out were just 'extreme' crossdressers ie, having a feminine side but their core gender identity was not female-others may or may not have been transsexual but just couldn't cope with the stress and social pressures involved...

Way to misrepresent things. This is a case of lying with statistics. They have a high drop out rate because they force you into full-time without the benefit of HRT. Maybe some transsexual men can do that, but it can, and is, a death sentence for some transsexual women. In this regard they VIOLATE the Standards of Care (not to mention the Hippocratic Oath). The SOC plainly say that HRT can be started [before the RLE. The English use this tactic to get people to drop out and the system saves money. It's called cutting off your nose to spite your face. In the short term the system may save money, but what of the cost to society when this person kills themselves in frustration? For example think about the impact that people like these have had on the world:

http://ai.eecs.umich.edu/people/conway/TSs...TSgallery1.html

Everyone has value. Everyone has something to contribute. Unfortunately the system in England seems to deem us as expendable, as less worthy of medical care. I can only think of one word to describe my feelings about that: DISGUST.

[Guest leo]

leah and sally very good reads!!!

i live in england leah

this topic is very interesting, keep posting girls

[Guest Zenda]

Way to misrepresent things. This is a case of lying with statistics. They have a high drop out rate because they force you into full-time without the benefit of HRT. Maybe some transsexual men can do that, but it can, and is, a death sentence for some transsexual women. In this regard they VIOLATE the Standards of Care (not to mention the Hippocratic Oath). The SOC plainly say that HRT can be started [before the RLE. The English use this tactic to get people to drop out and the system saves money. It's called cutting off your nose to spite your face. In the short term the system may save money, but what of the cost to society when this person kills themselves in frustration? For example think about the impact that people like these have had on the world:

http://ai.eecs.umich.edu/people/conway/TSs...TSgallery1.html

Everyone has value. Everyone has something to contribute. Unfortunately the system in England seems to deem us as expendable, as less worthy of medical care. I can only think of one word to describe my feelings about that: DISGUST.

Kia Ora Leah,

Feisty as ever I see , Perhaps you could enlighten me on the requirement both in the US and UK for obtaining HRT…Is the 3 month RLE period prior to obtaining HRT 'across the board' throughout the UK ? And in the US is there no such waiting period?

I must admit I’m not overly familiar with the British system, however I do know that the passing of the Gender Recognition Bill back in 2004 has greatly benefited British trans people-But as you well know “You can please some of the people some of the time –but not all of the people all of the time!”…There will always be those for whom a certain system is not very beneficial…And that sadly is a fact of life!!!

Tell me Leah overall, do you feel the American system when it comes to the treatment of trans-people is any better than in the UK? I ask this because when it comes to transsexual issues both in the US and UK you seem to be more clued up than me and I’m not trying to be sarcastic when saying that…You truly do seem to be quite knowledgeable when it comes to these sort of things …

Metta Jendar

[Guest Leah1026]

Tell me Leah overall, do you feel the American system when it comes to the treatment of trans-people is any better than in the UK?

As long as you have the resources (money) transition is much easier in the states. The vast majority of us start HRT before RLE. I was on HRT for about 20 months before I went full-time. And I know that I was in no shape to handle RLE without HRT. HRT made the RLE possible for me as things improved dramatically for me after I started it.

The problem is many of us do NOT have the money to transition. And even if we do sometimes employment discrimination causes us to lose our jobs and that money gets siphoned off for normal living expenses.

But if you have the money you can choose the therapist that's right for you. You can plan when and where you transition. You can choose your surgeon. None of which is possible in England unless you go private (assuming you have the money to do so). And as I said before not offering HRT until someone has been full-time 1 or 2 years is a death sentence for some people. If I had transitioned in England instead of in the USA I don't know if I'd be alive today.

[Guest B.heard]

This was a great topic to read over you all have some good point thanks Jendar

I personally voted for 12 months even though as a Brit I know Ill have to do the full 2 years, But a very good point Jendar bought up for me was the fact Im not that young and have lived a good few years as nothing (in hiding) and Im only now living as a guy but its alot to get used not in the sense of the gender but in the sense of social behavour, Im not used to girls waving at me or realising when Im angry about something I can look intimidating as a guy and a hundred other tiny things so for me I think a good 12 months RLT would allow that aspect to settle down.

On another note though I feel a RLT is pointless when the person doing it can't pass at least a good % of the time I know us FTM have a slight advantage with our HRT to some MTF I wish there was alot more offerd to those that needed it so if the RLT is a must then those doing it can do so with dignity and gain confidence.