Question: Outside the “Standards of Care”
Samson asks…
Has anyone had luck getting approved for hormones without following the “usual narrative” (‘I want to permanently transition to being ‘a member of the opposite sex’)?
Please post your response in the comments below.
» Ask Genderfork «
Posted by Alice on January 18th, 2011 at 04:00 pm
Category: questions 33 comments »
January 18th, 2011 at 5:16 pm |
Weeeell, lying is always an option.
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Will replied:
January 19th, 2011 at 11:56 am
lying in therapy is a supremely bad idea. If lying is THE ONLY way to get what you need, then do so extremely carefully so as not to damage yourself in the process.
But seriously, if you’re lying to your therapist, you need a new therapist. if your therapist pulls the crap of telling you they are the only one in the area who does gender stuff, call them on it and do your own research. you don’t have to follow the prescribed narrative of GID to get hormones, the trick is finding a therapist who is up to date and knows that.
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January 18th, 2011 at 5:25 pm |
I’m currently working on that. My therapist seems to get it, and we’ve already begun discussing HRT [hormone replacement therapy]. I’m optimistic that I’ll be approved, but I know how closed off so many can get about the trans community.
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January 18th, 2011 at 5:43 pm |
I have known several people who followed the lying approach. There is the option of self-medicating, but that isn’t a good idea unless you work in a hematology lab. It is a pity that there’s so much BS around this… I suppose they’re trying to safeguard our precious little welfare, but especially these days you not only have to lie, but you have to know what flavor of lie to give forth. Good luck and let me know what you find out!
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January 18th, 2011 at 6:40 pm |
I know a lot of genderqueer people that have started taking hormones (specifically T). I know they are doing everything through a endocrinologist. I don’t know how they went about getting their letter from their therapists bit you can probably find your answer on YouTube. A lot of genderqueer and nontranssexual people post their videos about hormones. Just send one a message or something and I am sure they will tell you.
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January 18th, 2011 at 6:46 pm |
Try honesty? If that doesn’t work, go to another therapist and try lying.
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January 18th, 2011 at 7:02 pm |
This is a question that has been bothering me. I want to start T really bad but I do not have the dominate transsexual narrative of having “always known”. I’m hoping I will be approved…
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Will replied:
January 19th, 2011 at 11:57 am
I didn’t either and I got approved and I never lied to anyone.
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noah replied:
February 16th, 2011 at 10:27 am
I’m the same way, I haven’t “always known” that I’m a gentleman in the body of a woman, because I was ignorant to the existence of transpeople, genderqueers, and even gay people for the majority of my growing up time.
It’s quite frustrating. But I’m lucky enough to have a therapist who will write “the letter” to an endocrinologist as soon as I’m ready.
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Jessica replied:
February 16th, 2011 at 10:57 am
I was talking about this with my partner just a few days ago… I haven’t always known I was trans, just because I was raised to think one’s gender was like your species… you may want to be a bird or an otter or dolphin, but it just is never going to happen, so, by that logic, if you’re a man, you’re a man, and if you are a woman, you’re a woman. It took me 40 years more to progress beyond this to an appreciation of the base cause of much of the unhappiness and strife I have had (and given others) in my life.
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Tommy replied:
February 17th, 2011 at 3:49 am
Me too…I’m working on it. I’ll let you know how that goes, if you’re interested.
Being in a country that is quite oppressive and fixed with religion and where I’ve had therapists tell me that I can’t be trans because I’m bisexual or even that I can’t be bisexual because I “have to choose!”, or that “most people like you kill themselves after the operation anyway, and you’ll never be able to orgasm” and crap like that…well, I don’t know how this will go :( I’m starting to think I should just have lied the whole time. Maybe I might be already on T if I did that…
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January 18th, 2011 at 7:37 pm |
I am a biological male who identifies as genderqueer. I’ve been injecting myself with testosterone for the past two months because I was diagnosed, due to lab work, with a disorder called hypogonadism. In my case, that means low testosterone due to a problem with the pituitary gland and endocrine system. In short, my body doesn’t produce enough T, and my health suffers as a result.
While being treated, I have also determined is that my body contains high levels of Estrogen as well, though medically it is referred to as Estrodiol. I mention all of this because, in doing my research, I have read a few medical reports that make a tentative correlation between hormone deficiencies like mine and gender identity.
I certainly do not hope that anyone experiences this condition, be they biologically male or biologically female, but it has nonetheless given me the opportunity to manipulate my hormone levels and in so doing observe their impact upon me. As a previous poster suggested, talking to an endocrinologist might produce a prescription for hormones. I do wonder how many people who identify as transgender or genderqueer have a similar hormonal makeup.
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Jessica replied:
January 18th, 2011 at 8:19 pm
More people who identify as MTF or genderqueer and take hormones to feminize develop drug induced hypogonadism. Finasteride, even when discontinued can break the normal endocrine engine that maintains proper Testosterone levels and enables erectile function (among other things).
I personally doubt that body feminization is the cause of transgender feelings. I would be interested in talking with you about the differences in how you feel and think with regulated Testosterone versus “inadequate” T.
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January 18th, 2011 at 7:48 pm |
Ugh. Sorry about that sentence. It should read…
“WHAT I have also determined…”
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January 19th, 2011 at 12:09 am |
It depends a lot on your doctor. My therapist straight-up told me, the first time I saw her, that if all I needed was a letter of approval she would just write me a letter. I ended up going to a doctor she recommended and never used the letter.
Depending on where you live, there may also be clinics (such as Howard Brown in Chicago) that follow an “informed consent” model—they take some time to tell you the risks, and then it’s up to you. Check out local trans or LGBT resource centers to find out.
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January 19th, 2011 at 2:21 am |
Thanks so much for posting this question–I’ve been wondering the same thing for a while now. This makes me hopeful that if I ever feel I should take T, that I don’t need to be transsexual to do so.
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January 19th, 2011 at 8:26 am |
I think that it is possible. Depends on finding the right therapist. Also, if available in your area, a doctor who uses the informed-consent model and doesn’t require a letter.
If possible, I would try inquiring to a trans/genderqueer community that exists in your area, or online forums giving the name of the city were you reside — such that people can give you suggestions regarding local resources.
With respect to a therapist, remember that their job is to help you in your journey. If they don’t, then I would suggest finding one that works for you (even if it takes a few attempts).
Best wishes!
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tigr replied:
January 19th, 2011 at 1:52 pm
“With respect to a therapist, remember that their job is to help you in your journey. If they don’t, then I would suggest finding one that works for you (even if it takes a few attempts).”
Seconded! Important point. I ‘wasted’ a year on going to someone who just wasn’t helpful (to me) at all… And after trying a bit more, I found someone who was super-helpful. (In that regard, I’m actually sad I moved away from there and can’t go to the good one anymore!) Also, sometimes (e.g. in my case) it can be more helpful to have a therapist who doesn’t just give you the prescription forms and that’s it, but rather talks with you a lot…
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January 19th, 2011 at 8:47 am |
I played by the rules but I’ve heard this can work.
Obtaining the hormones without a doc’s help, self medicate then find an open-minded doctor who is willing to prescribe refills on the basis that it’s safer, more reliable and your health can be monitored (liver/kidney functions, hormone levels, other things I could find my lab form and list if you’d like.)
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Jessica replied:
January 19th, 2011 at 9:03 am
I think that would be very helpful for folk.
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Will replied:
January 19th, 2011 at 12:05 pm
obtaining hormones from anywhere other than a legal pharmacy is really not a good idea. the relatively high rate of HIV/AIDS in the trans community is from people doing precisely this. have a little patience, do a little research, and go through proper channels (planned parenthood, free clinics, LGBT centers, therapists, dr.’s) Access to hormones is MUCH BETTER than it used to be and continuing to get better all the time. don’t assume it will be easier to go through back channels, when doing so could cost you your health and ultimately your life. if you aren’t mature enough to navigate getting hormones legally, you aren’t mature enough to be taking them at all.
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Jessica replied:
January 19th, 2011 at 12:10 pm
I think you are being somewhat simplistic. There are tons of issues here. Honesty and legality are a better and safer policy… but they are not an option to some folk. I am not willing to reject those people and call them immature or stupid because they make different choices than I do. I just hope they are careful and that their choices do not end up rebounding on them in harmful ways.
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Meike replied:
January 19th, 2011 at 1:46 pm
Plus, who’s to say that they were looking for “back channels”? Maybe they know a person being prescribed hormones. It’s not necessarily them getting hormones in the most sketchy and illegal way possible. But I still have to agree, getting hormones legally and honestly is the best way to go.
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Tommy replied:
February 17th, 2011 at 3:53 am
In some places this isn’t an easy (and sometimes not even avaiable) option though…
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k replied:
January 20th, 2011 at 1:49 am
I wouldn’t advise anyone to start hormones without a doctor’s supervision, regardless of whether the hormones were obtained through a pharmacy or through “back channels”, for precisely the reason why that plan might work: because hormone therapy carries medical risks, some of them severe. For example, estrogen therapy can cause lethal blood clots and testosterone therapy can cause liver disease. While some people successfully self-medicate with non-doctor-obtained hormones, if you go on any trans* forum on the internet someone will know somebody who has had very nasty medical consequences from doing so [particularly in the transfemale community with persons attempting hormone therapy with birth control]. Going to an endocrinologist who can regularly monitor your health and offer adjustments in your treatment if any problems arise is the best option, and if you can find one who will treat you there’s really no excuse for self-medicating.
If anyone is in a position where this is not possible, double-check that you’ve exhausted all your opportunities [local LGBT resources; trans* forums; free or public health care resources; low-cost or tiered therapy options] and if you believe hormone therapy is mandatory in your case and you cannot wait to get into a position where monitored therapy is possible [i.e. you feel as if you could not continue living without some sort of physical transition] then please read as much as possible on treatment, dosage, etc. before attempting to self-medicate. Know exactly what drugs or hormones you are using, their strength, and where they came from, and follow standard safety and hygiene procedures regarding needles if you inject yourself. Keep track of your progress and your health, especially if you have pre-existing conditions, and don’t hesitate to seek medical attention if any problems develop.
Hormones are heavy stuff, they aren’t to be used lightly. Everybody be careful and stay safe.
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Anonymous replied:
January 21st, 2011 at 1:01 pm
“self medicate then find an open-minded doctor who is willing to prescribe refills on the basis that it’s safer”
actually, people who self-medicate before going to a professional are far more likely to have a difficult time obtaining hormones because they have abused them in the past. i’m not sure how this works or why, but i have read about a lot of people who self-medicate and are then turned down for legitimate hormones of any kind because of it.
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January 19th, 2011 at 3:15 pm |
Yes, I have.
I had a very understand therapist who even when it was unclear if I wanted to actually fully transition was glad to write my letter. She was very keen on the idea that some variation of genderqueer was an acceptable outcome of transitioning.
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January 19th, 2011 at 10:03 pm |
Yes, I actually have a therapist who is very outspoken on trans rights, and she’s been amazing at dirrecting me to the endos she does and doesn’t trust, especially for non-gender-binary folks. But even she told me which things to be careful not to emphasise without actually lying when dealing with some of the intermediate red tape portions to be on the safe side as she was writing The Letter. And the endo I’m seeing in a larger Boston medical group considders HRT to be a rather normal and straightforward proceedure with little interrgation or demanding you to prove yourself – they actually have a part of their intake form asking for your prefered pronoun for the entire place from the GPs to the pharmacy.
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January 20th, 2011 at 1:57 am |
WPATH 6 [the official “standards of care”] actually does have provisions for providing hormone therapy for individuals who fall outside the “usual narrative”:
“Can Hormones Be Given To Those Who Do Not Want Surgery or a Real-life Experience?
Yes, but after diagnosis and psychotherapy with a qualified mental health professional following
minimal standards listed above. Hormone therapy can provide significant comfort to gender
patients who do not wish to cross live or undergo surgery, or who are unable to do so. In some
patients, hormone therapy alone may provide sufficient symptomatic relief to obviate the need
for cross living or surgery.”
The relevant section is on pages 13 and 14 of this document:
http://www.wpath.org/Documents2/socv6.pdf
If you feel like it would be helpful [i.e. you are comfortable with the other criteria in the Standards], you might show this to a therapist who is otherwise somewhat hesitant to approve you for hormone treatment.
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January 23rd, 2011 at 12:02 pm |
Wow, thanks so much for all the thoughts and ideas and info, everybody. I’m definitely waffling about whether hormones are something I want to pursue, and I figured others would want to know too, so–much appreciated.
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February 15th, 2011 at 8:00 pm |
Dont listen to these people, lying in therapy is perfectly okay. Therapists arent god, they’re specialists. Like car mechanics. I’d never tell my car mechanic that there’s a rip in the seat cushion or that my house has termites, why would I tell my therapist about parts of my life she has no business knowing.
now about the hormones, I got okayed for dermal patches at 5 mg a day without saying I wanted to transition. This was in California. Not that it matters really because NO PATCHES OR CREAMS WORK. NONE. if you want REAL results, injection is the way to go.
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Jessica replied:
February 15th, 2011 at 8:40 pm
“NO PATCHES OR CREAMS WORK. NONE.” Not true. Everyone’s body responds differently. Age, body type, and many other factors affect what will work and what will not work. Certainly, if you require rapid, dramatic results, then injections will achieve the maximum difference in the minimum time… but even then, I have known people who got better overall results with a more gradual process than mainlining an immediate boatload of hormones.
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Samson replied:
February 16th, 2011 at 4:17 pm
Indeed. I also have a friend using gel who’s doing quite well.
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