Therapists and Endocrinologists

me too, I'm planning to start on December..goodluck to us bro..

 

Well, the therapist will basically make sure you're certain of who you are and everything and then write you up a letter saying you're ready for t. If they're a good therapist (not some gatekeeper), they should give your letter within a reasonable time. Some peeps even get them their first appointment. Then you take that to your endo and there you go!

Once I find myself a job, I'm going the informed consent route cause I don't need nobody giving me permission and junk, you know? And I'm lucky enough that there's a place not too far away that offers it.

 

First the really really short version:

Therapists help you transition. Some of the help they give is referring you to an endo. Endos prescribe and monitor your hormones.

Now in depth,

So this stuff is pretty hard to make sense of. In the resources section there's a link to a paper called the "standards of care". But A.) It's long, B.) It's written in really formal language, and C.) Not everyone goes by them, they are just standards and guidelines. In general, though, those are the "rules of the game" if you are seeking medical help with gender mismatch problems.

So you don't have to read through all that, I'll try to sum stuff up as best I can. This stuff is also easier to explain right now if I do it backwards, and work from surgeries to therapists.

So for some of us that identify as transsexuals - I am one, although my favorite term is "transitioner", and to keep the language clear when I say transsexual I mean someone who changes their physical sex as part of their transition - there is some medical help we often go for, mix 'n match all but the first one:

The ladies:
* no medical help at all
* Hair removal
* FFS (Facial Feminization Surgery)
* "Orchie" (orchiectomy, it's a term for "castration" but a lot of people prefer "orchie" because they feel it has more dignity)
* "Top Surgery", breast implants (this one is a little more rare)
* "The Surgery", neovaginoplasty, making a vagina usually out of either what used to be the scrotum, or part of the colon, or (very recently) some of your cheek cells.

And the fellas:
* no medical help at all
* "Top Surgery", mastectomy or breast removal
* "Getting rid of the plumbing", hysterectomy, roughly equivalent to orchie
* The Surgery", usually either phalloplasty where a new penis is made, or metoidioplasty where they turn his clitoris into a penis.

So the reason I listed all that out and why it's relevant. For things further down the list, most doctors want you to have a letter of recommendation from a therapist. In fact, for the surgeries at the bottom of each list, 2 letters. As you get higher up on the lists, you will run into fewer and fewer requirements.

Now this view of therapists as a check-box before you get surgery is a little problematic IMO. But if this is how you honestly view them, in many situations you can simply drop in for a single office visit and Bob's your uncle.

So Cassie, if therapists aren't there as guardians of the sacred transition realm, what are they for? There's a ton of paragraphs and you haven't even answered the question! And I have to scroll down to see everything else you wrote! Well first (sorry) there is a lot of controversy and politics surrounding us unfortunately. There are basically a lot of ethical questions with no easy answers.

Some of this is serious stuff. For example, something doctors used to do is use SRS techniques to "correct" intersex conditions. This basically turned people trans and caused a lot of problems because, as I'm sure you are aware, the trans never goes away, and transitioning is simply out of reach for a lot of us. The result is really heart-wrenching, and it does still happen even today

And some of it is just unfortunate. In brief, some very famous and connected people transitioned for the wrong reasons, and got the courts involved, and as a result access to SRS became both a hot button issue, and an issue for doctors who rightly felt they needed to protect themselves.

So a lot of people turned to the mental health profession to solve this problem. It's not always the best solution, but it is a solution. So that part of a therapist's job is to make sure that you aren't transitioning for any unethical reasons (two paragraphs ago), and you understand it's your decision (last paragraph).

Nothing more than that; if your therapist is demanding that you buy a prada bag and have a male lover for an MtF transition, they are wrong and you need to find a different one. Don't ever let anyone make you feel you have to prove how desperate you are, or tries to get you to live up to their expectations of who you should be, to get help. These are both very real problems in the trans community, and you are doing no one any favors if you comply with it. But these are also much more rare problems. I think you'll find that the bad therapists are very few and far between. They do make these people to through a lot of college.

And really, that's not what I think a therapist's role should be anyway, and I think most good therapists would agree with me. You are paying these people lots of money, get your money's worth! So to finally answer your question. I think a therapist is someone you pay to help you transition. Changing your physical sex is tough. You're doing it in the middle of a society that is a lot friendlier than it ever has been, but still can't even manage to reliably give us a place to pee. The biggest irony is that you have to be incredibly successful and resourceful to transition successfully - and the fact that you have gender dysphoria to begin with works against that.

So when I was seeing a therapist I put him to work. That was the first time I found out about the Standards of Care. He tracked down a laser hair removal place for me. He was amazingly helpful with my relationship with my girlfriend - we aren't exactly lovers in the traditional sense any more, but we are closer in a lot of ways than we ever have been and are still living together. And the screening therapist beat him to it but he introduced me to my first trans support group at the school. I never took him up on it, but I had a safe place to show up dressed as myself if I wanted it. I did show up as myself to support group. And the help I got enabled me to balance a heavy courseload and graduate from college. He even offered to help me bring in my family and help me come out to them!

So that's therapists. And now that I've covered all that, endo doctors are going to be easier to explain. An endo doctor has this job:

* help you with your transition by providing you with hormones
* make sure the hormones don't make you sick

Some endo doctors require a letter from a therapist, some don't. The ones that don't advertise working under the "informed consent" model, which means you have to be an adult. It just means that the endo doctor has a different way to take care of the two concerns earlier. Some are better than others. You will want to visit them frequently so they can keep track of your blood hormone levels, and you will need to be up front with them about your transition goals.

I would really recommend a therapist if you are going to see an endo doctor, but also to try to educate yourself as well.

And also, since you are part of the queer community whether you're gay before or after transition, or were bi, pan, or ace the whole time, or are your own unique brand, I would get out there and make friends too. Queer people are just the most understanding wonderful people alive. I know you didn't ask about this specifically but I really think having people you can safely transition around is just as important as a good therapist and endo doctor.

 

I would like to point out an oft-repeated "fact" that is no longer true. Well, at least here in Red Texas it's not true; I should hope that it's the same in other states.
It is: you need a letter from your therapist to go see an endocrinologist and ask for hormones. The letter is not required. Doctors often ask for one as it seems the responsible thing to do. This is directly from my therapist:
"It used to be that you're required to have 3 months of therapy and a letter from your therapist [to start HRT, hormones replacement therapy], but that was considered onerous for some people (costs etc.); plus as activists for the trans community, we're not comfortable being put in the role of gatekeeper, of saying who can transition and who cannot.
"But most doctors will ask for a doctor from the therapist; I'll be happy to provide that at any point.
"Once they have the letter and blood work results back, they will start you on hormones.
"If you were interested in SRS (sexual reassignment surgery), there's a certain period of time, I think it's a year, where you have had to live full time as a woman."

---------- Post added 14th Oct 2013 at 12:20 AM ----------

Oh, and to answer your original question: therapists cannot prescribe anything.
Perhaps you can ask on a locale-specific support forum for a "friendly" doctor who will prescribe hormones w/o needing a letter from a therapist (which, at least in TX, is not required). I found via Google one local doctor who freely prescribes hormones for MtF trans people. That doesn't help you; just pointing it out that it's possible to find such doctors.