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WPATH Standards Of Care Version 7 – What’s the hold up?

The latest edition of the WPATH (previously Harry Benjamin SOC) Standards of Care have been released for transgender, transsexual and Gender Nonconforming People.

But again although beginning to catch up why are they so behind what we know already?

It shows that they are not listening. And seem to be almost grinding to a halt with their influence over early treatment worldwide. These are guidelines but they are either ignored, changed by practitioners country by country (in some cases to prolonging the value of their charge (stringing them out to make more money)), or do not match religious or political views of many governments. They are at base camp and the trans community are at the summit, we could throw you a rope but i think theyd rather use their own!

When WPATH was first created and ‘rebranded’ from the old Harry Benjamin SOC – quite why they dropped his honour one can only assume changes made were such that vanity press was no longer acceptable.

At that time I raised the issue with the then chair why they did not include the term ‘and Social Care’ WPATH World Professional Association for transgender Health …. and social care.

The reason is quite obvious.

This organisation is run by postgraduate academics – you need to be a doctor or have the equivalent qualification to be taken seriously by them. Most people who work with transgender people are lay people, or transgender people themselves offering support out of the goodness of their heart. Social care is the number one problem here, society the media and the newspapers, this is what makes a transperson suffer. It is no good waving the WPATH standards of care at someone ready to kick your head in. It is simply clnical guidance to protect practitioners when carrying out their duties. And the very fact those attending these conferences can afford to cross the Atlantic take time off work and give speeches preaching to the converted suggests its very lucrative too. Not something they’d give up easily and allow practice nurses and social workers to take a bigger role in. Apart from the surgery itself, and by UK standards has not improved since Mr.Royle showed the current crop how to do it 10 years ago, what is the point?

Most people who work in frontline care, the people who run support groups those that fill all the gaps between the visits to the gender clinics – who for the most part suffer some inadequacies. I mean I have been saying for 10 years that the term disorder was out of order. Only last year did the DSM-IV decide it was too and that it should be reclassified as gender incongruence.

The association is run within the biomedical model not within the psychosocial model (this is beginning to change but why so long?), Disabled people (not that being trans is a disability as such) are disabled by their environments not by their disabilities.

Wpath for the most part is a barrier, it has been obvious for decades that not using puberty blockers on teens and forcing them through puberty was child abuse, now that’s beginning to change.

But I just look at this and wonder why they simply do not ask us – we could have told them most of these things decades ago by know they would be in better shape, but the arrogance of office closeth the ears sadly!

The very fact there is the need for these regulations at all bothers me.

If you wanted a rhinoplasty (nose job) you would not be forced to live for a year with a false nose to make sure it is what you want.

These standards of care are for the practitioners and the social circle around the transperson, or for government agencies to protect (and control us) society from us.

I think once a transperson decides they want surgery they should simply go and be put straight on the waiting list for it or go and get it as easy as a tattoo or a nose kob, an afternoons counseling and ‘sign here’. For those that want or need more then that is where the gender clinic steps in.

This would seriously unburden the clinics from this ridiculous charade.

Almost all of it is falsifiable. For the handful of people who regret surgery there are equally if not more who are unhappy about their new nose. That’s life.

If we examine the ‘buzz words’ in this latest oeuvre we find terms like ‘Cultural’, ‘awareness’, ‘social and political’, ‘public policies’ and so on.

I don’t actually think they come close to achieving these goals at least in the UK. In the US where there is no NHS then will the eminent doctors operate on the poor transpeople and make their lives and I quote, “with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment.” in a sort of pseudo MÉDECINS SANS FRONTIÈRES effort – no, so the care depends on your bank balance, so lets call a spade a spade here this is all ‘dressing’.

If you have $20 (US) grand of course otherwise there is the door – thank you come again!

Surgery and well-being offered by this crowd is a business, lets not forget that. WPATH is really nothing
more than chamber of Commerce AGM.

It has taken groups like Trans Media Watch and Tzone to begin to challenge the media and its very hard
work, cataloging and archiving media and abuse we find and then relaying this to broadcasters. I suppose when the media comes into line then society will follow, and then WPATH will take the credit for this social change? I’d give it 10 years before they do just you wait n see ;)

If we take away all the buzz words like , ‘health’, ‘well-being’, ‘excellence’, ‘care’, ‘expert’, and all the other terms used to sell asprins on television, we are left with the core of the document and lets take a quick look at that.

Remember the Core of the NHS refoms, NHS Act and Community Care Acts in the UK are about patient choice.

This document offers little or no choice – if you refuse to follow it you are unlikely to be treated.

Reproductive options

it would have been nice if I had been offered this – sperm storage, but I was not I did ask. in 10 years of UK care. Electrolysis in the UK is a joke too, even up to the point of surgery little or no support is offered in this case. As many transpeople suffer finding work – those that do not pass can well end up on the dole queue or worse, then the cost of attending sessions even in London can be a case of train ticket, heat or eat for many. Not all benefits cover even NHS care.

Next

“The SOC may also be used by individuals, their families, and social institutions to understand how they
can assist with promoting optimal health for members of this diverse population.”

In the UK most GPs still do not have the first clue about trans issues as many a transperson reports to us regularly, and that’s their core market. I personally carried out research with 115 mainstream health and social care agencies 10 years ago, almost all had no idea about what transpeople were, or what to do if they arrived in their care. From this then Age Concern and other groups like Mind began to approach this subject more seriously. At no point were the HB SOC (at that time) mentioned or needed. These are social care organisations why would they need these SOC? But they will take credit for the changes today.

“WPATH recognizes that health is dependent upon not only good clinical care but also social and
political climates that provide and ensure social tolerance, equality, and the full rights of citizenship.Health is promoted through public policies and legal reforms that promote tolerance and equity”

Hackneyed PC commentary. Go ask your local MP right now what WPATH is and not to use Google ;) and I think you will have your answer. In anycase MPs are again at the top politicians play to the masses, if the masses are ignorant – and society still is for the most part, then again this paper is making claims it simply cannot cash. I see it more of a wishlist. Like Miss world wanting world peace and an end to starvation. laudable and tear-jerking but nothing more.

Interesting, but most social workers work in multidisciplinary teams, but there will always be a big divide between the medical view (scientific bio model) and the social carer which is less tangible and more emotionally demanding in the long term, A doctor today in a Family practice in the UK offers 6 mins for a normal encounter and 10 mins for counselling – you do the math!

Like the Wizard of OZ many a clinic just as well be in the Emerald City for the ease in which they are accessible. They certainly ain’t no A+E for transgender people, who tend to go it alone, self medicate, and struggle, some so poor they cannot even attend a support group, after all that even requires some funds even for a cup of tea and that’s if you live in a major city. The yellow brick road is a long and unnecessary one.

I raised the issue of what i have coined the ‘transgender biological clock’, this is quite serious, a child who has liberal parents, and an environment of safety and security can come out at say 6 and then have the luxury of 6 years to prove they are serious before puberty destroys them leaving a future of playing catchup and regret. However a child of 10 only has 2 years, if a child of 11 ‘comes out’ its already too late based on these guidelines, puberty will be already breaking the voice by the time they get even close to a gender clinic, when the local doc has a prescription pad! A GP should be able to prescribe blockers until they have seen a specialist. One day they will but you heard it here first, Ill give it another 10 years until they get their finger out and listen to sense.

“While the SOC are intended for worldwide use, WPATH acknowledges that much of the recorded
clinical experience and knowledge in this area of health care is derived from North American
and Western European sources.[...]It is impossible for the SOC to reflect all of these differences. In applying these standards to other cultural contexts, health professionals must be sensitive to these differences and adapt the SOC according to local realities. For example, in a number of cultures, gender nonconforming people are found in such numbers and living in such ways as to make them highly socially visible (Peletz, 2006). In settings such as these, it is common for people to initiate a change in their genderexpression and physical characteristics while in their teens, or even earlier.”

Again this can set some cultures back, in some cultures a young person who shows these characteristics is raised as a girl (in this instance) and socially acceptable, however guidelines like this can damage these cultures, and turn something socially acceptable into a clinical issue. A bit like taking the Spanish Inquisition to the Native South Americans, and we all know where that went! New ideas are not always welcome and can be seen as hierarchical bullying rather than helping. Suggesting this will somehow be flexible enough to go away is unworkable. Flexibility in the terms of this paper is ‘on their terms’!

“Exhibit respect for patients with nonconforming gender identities (do not pathologize differences in gender identity or expression); provide care (or refer to knowledgeable colleagues) that affirms patients’ gender identities and reduces the distress of gender dysphoria.”

Seriously? They have pathologised this, the very fact that it is an arm of the UK mental health service proves that, to lose this tag they will have to give away this service and the Standards of Care with it. Again if you want plastic surgery you can choose to have it when you wish, and you are not press ganged into the mental health system for requesting it. Transsexuals are – this statement above is laughable! Why do you need a knowledgeable colleague to determine ones fashion sense? Ridiculous! It’s all smoke and mirrors, I am amazed it has managed to work for so long unchallenged to be honest.

POT AND KETTLE

so to the core of the document

“WPATH released a statement in May 2010 urging the de-psychopathologization of gender
nonconformity worldwide (WPATH Board of Directors, 2010). This statement noted that “the
expression of gender characteristics, including identities, that are not stereotypically associated
with one’s assigned sex at birth is a common and culturally-diverse human phenomenon [that]
should not be judged as inherently pathological or negative.”
Unfortunately, there is stigma attached to gender nonconformity in many societies around the
world. Such stigma can lead to prejudice and discrimination, resulting in “minority stress” (I. H.
Meyer, 2003). Minority stress is unique (additive to general stressors experienced by all people),
socially based, and chronic, and may make transsexual, transgender, and gender nonconforming
individuals more vulnerable to developing mental health concerns such as anxiety and depression
(Institute of Medicine, 2011). In addition to prejudice and discrimination in society at large, stigma
can contribute to abuse and neglect in one’s relationships with peers and family members, which
in turn can lead to psychological distress. However, these symptoms are socially induced and are
not inherent to being transsexual, transgender, or gender nonconforming.”

2010!!! For goodness sake and these are the ‘experts’ – it is embarrassing, I could have told them that for free 20 years ago. They are part of this problem not the solution. To succeed they will have to become the architects of their own destruction I am afraid.

There will always be transpeople unsure, and families who need some proof their trans family member is not ‘barking’ but that’s fine, but everyone else should be set free! This statement is also moving beyond its
remit as an organisation. It is stepping into grass roots social care, the media and press that they have little or no control over other than looking learned posing in documentaries or vanity press.

“Some people experience gender dysphoria at such a level that the distress meets criteria for a
formal diagnosis that might be classified as a mental disorder. Such a diagnosis is not a license for
stigmatization or for the deprivation of civil and human rights. Existing classification systems such
as the Diagnostic Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association,
2000) and the International Classification of Diseases (ICD) (World Health Organization, 2007)
define hundreds of mental disorders that vary in onset, duration, pathogenesis, functional disability,
and treatability. All of these systems attempt to classify clusters of symptoms and conditions, not
the individuals themselves. A disorder is a description of something with which a person might
struggle, not a description of the person or the person’s identity.”

This is a cross-over point, whilst it is important to have the ability to treat co-morbidity, a person with mental health issues may still be trans in the same way a person without a leg maybe trans, but it also could apply to someone who is suffering serious depression over having a flat chest or their large nose also requiring medication, but which one of these is most likely to create shame and embarrassment? Or even make the papers, and which of these is more likely to generate sympathy? Again it is obvious the transperosn in mental health is, despite being in exactly the same dysmorphic state. It is not necessarily the fault of WPATH but the association does stigmatise they cannot say it does not.

“Thus, transsexual, transgender, and gender nonconforming individuals are not inherently
disordered.”

Strange that these exact same experts have said they were disordered up until last year! Can you now trust their views when they have got it wrong for so long? They have still got it wrong – they just do not listen and act quick enough – i’ts like stiring treacle and I suspect the amount of practitioners with any power at the conference who are trans themselves you can count on one hand!

“Formal epidemiologic studies on the incidence3 and prevalence4 of transsexualism specifically or
transgender and gender nonconforming identities in general have not been conducted, and efforts
to achieve realistic estimates are fraught with enormous difficulties (Institute of Medicine, 2011;
Zucker & Lawrence, 2009). Even if epidemiologic studies established that a similar proportion of
transsexual, transgender, or gender nonconforming people existed all over the world, it is likely that
cultural differences from one country to another would alter both the behavioral expressions of
different gender identities and the extent to which gender dysphoria – distinct from one’s gender
identity – is actually occurring in a population. While in most countries, crossing normative gender
boundaries generates moral censure rather than compassion, there are examples in certain cultures
of gender nonconforming behaviors (e.g., in spiritual leaders) that are less stigmatized and even
revered (Besnier, 1994; Bolin, 1988; Chiñas, 1995; Coleman, Colgan, & Gooren, 1992; Costa &
Matzner, 2007; Jackson & Sullivan, 1999; Nanda, 1998; Taywaditep, Coleman, & Dumronggittigule,
1997).”

So to put it bluntly – peeing into the wind! They admit they have little evidence other than that gleaned under the pressure of the gender clinic and as i mentioned earlier many cultures do not conform to this view. So they are basing their entire paper on what was conducted by Benjamin with some bolt on and “new PC speek”. The gender clinic is not such a good place to gather data, for one the majority of transpeople don’t go near one unless they want surgery at some stage, the fear of slipping up and upsetting one’s practitioner is such that they are often told what they want to hear or are briefed by friends as to what to say to expedite their treatment. Patients often lie to their practitioners. “Have you stopped smoking?” “Yes” – then they light up outside. Have you lived and worked as a woman (or man) yes – no :) They have no way to check short of using a private detective. The evidence they have is based on a western view, and you know the west is not the best example of how to treat transgender people necessarily.

In social care data is often gleaned in longitudinal studies, this maybe watching say a child grow from perhaps being abused to following them through the criminal justice system and into foster care and then into adulthood and their new family and successful life. These essential longitudinal studies simply do not work in a hospital as well. Why? Because they have a tighter treatment schedule and patients who ‘hang about’ are viewed as ‘bed blockers’. The same applies to some extent in the gender clinic, ship em’ in and ship em’ out. It is becoming a production line. Discharged patients i suspect rarely ever will speak to those practitioners again, So they are unlikely to know what really happened to them after that.

If you are treated abroad then this followup is even less likely, I mean this is not a bad thing but it kinda does demonstrate the true value of the care, in other words just a means to an end, delaying someone for a year or more rather than actually helping them get on with it – more hindrance than help.

“Other clinical observations (not yet firmly supported by systematic study) support the likelihood of a
higher prevalence of gender dysphoria: (i)”

Not supported by systematic study. Anyone with research knowledge understand that the double blind randomised control trial is the ONLY true research method. After that it can become evidence based from
encounters, social or ‘action research’ and so on. However, this is subject to the bias (or ‘research artifacts’ the way questions are posed – the have you stopped beating your wife question yes or no makes you guilty!) of the researcher. Most of this research is in a one to one session, that are not supervised by a ethical panel.

Example, when was the last time you were interviewed by a group of specialists for research at your gender clinic? I do not mean them having someone ‘sit in’ on your meeting who they are training. I suspect it is likely most would say never. Therefore that practitioner can say anything they like, who can argue? Research is only as good as the weakest link – and the weakest link is clinical ambition. I simple terms they can make it up as they go along ;)

Options for Psychological and Medical Treatment of Gender Dysphoria

It is interesting here that they somehow claim ownership for a number of these treatments, only one applies as far as I can see and that is hormones and genital surgery.

“Changes in gender expression and role (which may involve living part time or full time in
another gender role, consistent with one’s gender identity);
• Hormone therapy to feminize or masculinize the body;

Yes but many self prescribe as it’s more trouble than it is worth especially in countries where to come out about this officially could result in one being brutally attacked.

• Surgery to change primary and/or secondary sex characteristics (e.g., breasts/chest, external
and/or internal genitalia, facial features, body contouring);

Yes but look how they bunch this up to somehow validate the other treatments as somehow related

Genitals – yes

But Breasts,facial features and body contouring can be achieved by just going to a plastic surgeon who has never heard of WPATH tomorrow!

• Psychotherapy (individual, couple, family, or group) for purposes such as exploring gender
identity, role, and expression; addressing the negative impact of gender dysphoria and stigma
on mental health; alleviating internalized transphobia; enhancing social and peer support;
improving body image; or promoting resilience.”

This again is licensing themselves with this task. No amount of psychotherapy will prevent someone passing a transperson and spitting on them if they are disgusted by it, the people who actually need the psychotherapy for the most part are the social circles and society itself, and not the transperson at all.

Again people are disabled by their environments and not by their ‘disabilities’, if a person cannot access a shop it is because they do not have a ramp for their wheel chair. The same applies for transpeople if a transperson is abused by society, psychotherapy is a sticking plaster that will peel off again, the root of the problem is society itself, but that is impractical to treat, but that is the solution. Education, communication and information – oh the tzone mantra – how about that?

Options for Social Support and Changes in Gender Expression

Hmm and here we go – I wondered how long it would be before they got their fingernails into us ;)

“In addition (or as an alternative) to the psychological and medical treatment options described
above, other options can be considered to help alleviate gender dysphoria, for example:
• Offline and online peer support resources, groups, or community organizations that provide
avenues for social support and advocacy;
• Offline and online support resources for families and friends;
• Voice and communication therapy to help individuals develop verbal and non-verbal communication
skills that facilitate comfort with their gender identity;

Ah the voice communication? Hmmm that reminds me of something – Transgenderzone.tv – ah yes way ahead of you guys ;)

• Hair removal through electrolysis, laser treatment, or waxing;
• Breast binding or padding, genital tucking or penile prostheses, padding of hips or buttocks;
• Changes in name and gender marker on identity documents.”

All things they do not even need to even see a doctor for.

Differences between Children and Adolescents with Gender Dysphoria

Now this is something I agree with (AT LAST), why(?), because children are longitudinally studied, as until they are 18 then they are almost under the control of the state. A child who is gender dysphoric at 6 and is medicalised, is going to be followed perhaps more closely for the next 10 years. So the data gleaned is much more accurate. It also shows that there is now an opportunity to block puberty or treat adolescents as early as possible. This is good stuff. Something unheard of when I was young – this is progress!!!
One of the researcher Peggy Cohen-Kettenis is very good at this. I’d recommend reading this section. Especially in light of the recent trans school kid headlines.

“Among adolescents who are referred to gender identity clinics, the number considered eligible for
early medical treatment – starting with GnRH analogues to suppress puberty in the first Tanner
stages – differs among countries and centers. Not all clinics offer puberty suppression. If such
treatment is offered, the pubertal stage at which adolescents are allowed to start varies from Tanner
stage 2 to stage 4 (Delemarre-van de Waal & Cohen-Kettenis, 2006; Zucker et al., in press). The
percentages of treated adolescents are likely influenced by the organization of health care, insurance
aspects, cultural differences, opinions of health professionals, and diagnostic procedures offered
in different settings.”

This bothers me – and makes a sham of the WPATH guidelines, as it is really with children we can see the true value of WPATH and its influence. If practitioners are ignoring these guidelines and refusing to treat trans children in this way then again it brings the whole WPATH recommendations into disrepute as they are clearly seen as without value by said practitioners – and shows them just as guidelines not rules – to ignore this worries me. As clearly many still disagree with them. With adults this is more easily fudged, but not with kids! As records are kept by too many agencies to allow the ‘do as I please’ and this inc Social services.

The sooner these guidelines for children are adopted internationally the better. It will almost dry up adult services if they are, other than those whose social circle make transition impossible until later years.

The next few sections are about competence to practice

This interesting though,

“Postoperative patients should undergo regular medical screening according to recommended guidelines for their age.”

Many cannot get away fast enough and the long term luxury of followups may apply in the affluent or the insured, but maybe not so in a country where someone maybe jobless and need fifty quid for a train ticket. In what is a full to bursting gender clinic already oversubscribed.

If you are planning on surgery its worth reading above and below ‘Urogenital Care’.

The section Terminology is worth a read particularly DSD and intersexuality. Disorders of Sex Development is still not used by manay as it has the term ‘disorder’ and as such the term intersex remains adopted by their community.

LASTLY THE REAL LIFE TEST OR NOW REBRANDED TO

Criteria for Surgeries

“As for all of the SOC, the criteria for initiation of surgical treatments for gender dysphoria were
developed to promote optimal patient care. While the SOC allow for an individualized approach
to best meet a patient’s health care needs, a criterion for all breast/chest and genital surgeries
is documentation of persistent gender dysphoria by a qualified mental health professional. For
some surgeries, additional criteria include preparation and treatment consisting of feminizing/
masculinizing hormone therapy and one year of continuous living in a gender role that is congruent
with one’s gender identity.
These criteria are outlined below. Based on the available evidence and expert clinical consensus,
different recommendations are made for different surgeries.

The SOC do not specify an order in which different surgeries should occur. The number and
sequence of surgical procedures may vary from patient to patient, according to their clinical needs.
Criteria for breast/chest surgery (one referral)
Criteria for mastectomy and creation of a male chest in FtM patients:
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC for children and adolescents);
4. If significant medical or mental health concerns are present, they must be reasonably well
controlled.

Hormone therapy is not a pre-requisite.
Criteria for breast augmentation (implants/lipofilling) in MtF patients:
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC for children and adolescents);
4. If significant medical or mental health concerns are present, they must be reasonably well
controlled.
Although not an explicit criterion, it is recommended that MtF patients undergo feminizing
hormone therapy (minimum 12 months) prior to breast augmentation surgery. The purpose is to
maximize breast growth in order to obtain better surgical (aesthetic) results.

[ICE MAIDENS NOTE - They cannot make demands on breast augmentation as its freely available]

Criteria for genital surgery (two referrals)
The criteria for genital surgery are specific to the type of surgery being requested.
Criteria for hysterectomy and ovariectomy in FtM patients and for orchiectomy in MtF patients:
1. Persistent, well documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled.
5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless
the patient has a medical contraindication or is otherwise unable or unwilling to take
hormones).
The aim of hormone therapy prior to gonadectomy is primarily to introduce a period of reversible
estrogen or testosterone suppression, before the patient undergoes irreversible surgical intervention.
These criteria do not apply to patients who are having these procedures for medical indications
other than gender dysphoria.
Criteria for metoidioplasty or phalloplasty in FtM patients and for vaginoplasty in MtF patients:
1. Persistent, well documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless
the patient has a medical contraindication or is otherwise unable or unwilling to take
hormones).
6. 12 continuous months of living in a gender role that is congruent with their gender identity;

Although not an explicit criterion, it is recommended that these patients also have regular visits
with a mental health or other medical professional.

Rationale for a preoperative, 12-month experience of living in an identity-congruent gender role:
The criterion noted above for some types of genital surgeries – i.e., that patients engage in
12 continuous months of living in a gender role that is congruent with their gender identity – is
based on expert clinical consensus that this experience provides ample opportunity for patients to
experience and socially adjust in their desired gender role, before undergoing irreversible surgery.
As noted in section VII, the social aspects of changing one’s gender role are usually challenging
– often more so than the physical aspects. Changing gender role can have profound personal
and social consequences, and the decision to do so should include an awareness of what the
familial, interpersonal, educational, vocational, economic, and legal challenges are likely to be, so
that people can function successfully in their gender role. Support from a qualified mental health
professional and from peers can be invaluable in ensuring a successful gender role adaptation
(Bockting, 2008).
The duration of 12 months allows for a range of different life experiences and events that may
occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school
experiences). During this time, patients should present consistently, on a day-to-day basis and
across all settings of life, in their desired gender role. This includes coming out to partners, family,
friends, and community members (e.g., at school, work, other settings).
Health professionals should clearly document a patient’s experience in the gender role in the
medical chart, including the start date of living full time for those who are preparing for genital
surgery. In some situations, if needed, health professionals may request verification that this
criterion has been fulfilled: They may communicate with individuals who have related to the patient
in an identity-congruent gender role, or request documentation of a legal name and/or gender
marker change, if applicable.”

“Patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity.”

Again almost all the reasons given are about the social circle and how well they are doing with it rather than the individual themselves. A little too much emphasis is misplaced here. Many transpeople say tough I am being selfish and get over it! But it does suggest there is an easing of the demands within the rlt at least and something i have raised for years. At last it has dawned on them that the shorter the rlt is and the less demands made on someone through it the better and more ‘normalised’ it becomes.

I personally think this should be optional and the gender clinic should have some consent form – like a surgeon where an individual can waive this 1 year demand, if they want surgery, especially if they have been living ‘en role’ for years already, then just let them get on with it – sign here!

Conclusion

You know if this crowd had only asked and listened to the voices they serve what to do 2o years ago they would now be twenty years further ahead. The guidelines they adopt as full of holes, most of the world ignores them, of those who have adopted them, they are seen my many as being press ganged into the mental health service, no matter how you dress it up that’s what it is!

When the NHS was first formed Bevan – the architect of it said this

“I stuffed their mouths with gold!” When saying what he had to do to win over the powerful hospital consultants.”

And although terminology changes, and political correctness introduces what seems a PR document as much as guidelines, if we actually look really closely it is very lack luster and still playing catch-up. The only ‘EXPERT’ here is the transgender person they see and these professionals are nothing more than care managers following a script.

These same professionals 50 years ago would have put you in an asylum, these same professionals labeled you as ‘disordered until a year ago.

Stop naval gazing and start listening to us and acting upon it. Your colleagues are clearly not the best source for improving your service – we are!

Use it!

To quote Mel Brooks from his hilarious film High Anxiety where he plays a Psychiatrist in a homage to the master of suspense Alfred Hitchcock.

Asked why he didn’t pursue a singing career he responds, “The big bucks are in psychiatry!” ;)

IM

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