Wednesday, October 13, 2010

The Standards of Care, hormones, transition, and is this for real?

Well I guess it is time to post something controversial rather than small insights into my life and people I have known. Here is a reasonable explanation of how the current Standards of Care (SOC) are supposed to work and to be blunt the entire process is shocking because I realize I am out of touch but I am completely baffled by the process and the order in which the process works.

Real Life Experience (RLE) before hormones is so different from back in the "old days" I am not sure I understand the reasoning. Why would someone start living as a female before starting hormones? It is sort of contradictory isn't it? I understand how totally out of touch I am with how things are done today but RLE before hormones is sort of indicative they want proof the person is transsexual and the only way to prove it is to suffer by having to move into the female role without any feminization and walk into the real world baring your soul to everyone because there are few transsexuals ready for RLE without some feminization. Is it some kind of right of passage where being possibly clocked, read, pointed out, and harassed is the gauntlet that must be survived? It is almost like they want you to publicly fail.

I guess this is why I feel I have no right to tell anyone what to do when they transition and how to live during their transition and likewise after surgery. Is the SOC exactly how everyone does it today? I know the answer is that some do because I have found the blogs on T-Central quite interesting and informative and many have followed a pattern Harry would approve of which is contrary to the SOC. 

I have been enthralled by Shandy  on her blog because I think she has gone about the process amazingly well and in a manner Harry would approve of. She is ready right now when she decides to transition and in my mind ready for surgery whenever she wants it. She certainly has not followed the SOC.

Do they penalize transsexuals that do not follow the SOC?  Is this a result of the input loons like Blanchard and his cronies have had?

I guess I would like someone to explain the rationale behind why the SOC is the way it is?  Help!!!


Melissa said...

What a refreshing voice! Thank you Elizabeth! I couldn't agree more! What we have with SOC, is a gate keeper system. That is complete anathema to me!

Melissa XX

Anne said...

I just finished reading Dr. Benjamin's, "The Transsexual Phenomenon". THANK YOU SO MUCH FOR PROVIDING THE LINK.

I found it totally enthralling and got through the entire read in one sitting. What I did not find was any referrence to the SOC's. Did he come up with those later? Was he the actual source/author of the SOC's?

I AM aware that WPATH and HIBIGDA has re-written them, and that CAMH, and the BLZB Gang of FOUR have also added their own interpretations.

What I see as the problem is that there has been little follow-up into those all important distinctions that Harry just began scratch the surface of, (his Types IV, V, and VI, just for starters).

It is unfortunate that these distinctions have been perverted into some kind of politically incorrect, (IMO NON EXISTANT) HIERARCHY.

In addition those few follow-up studies have been unfairly focused by an agenda driven narrative conducted by either gay men or autogynphilic transgenders.

I mean it seems so simple to me and yet there is so much written and so any studies that just do not make any sense.

Why deny differences when they clearly exist in order to fit into some politically motivated model?

AS for the rational for the SOC, it seems reasonable to move forward through this process, carefully and deliberately. To provide SRS and or HRT willy nilly on demand would IMO be highly irresponsible.

My guess is that while the intentions of the "gatekeepers" or caregivers are GOOD, they are hindered in their SUBJECTIVE perceptions.

Like Dr. Benjamin noted, most if not all of these studies are conducted from "outside" looking in. Why are WE, those of us who have actually "been through the process", not able to provide the benefit of ACTUAL REAL LIFE EXPEIENCE.

There is no doubt that our individual journeys have been different, but there are some interesting similarities. For one both Elizabeth and I had supportive mothers. In my case at least and from my assessment of Liz's writtings, this was a crucial factor, allowing for our early and successful transition.

Anne said...

Another thing that comes to mind is "Who ARE these guys, who are making these judgements?" HOW/WHY are they experts? Is it because they have "studied" dozens? hundreds? of individuals? Were they TG, TS, GQ, effeminate gay? How did they make that distinction? Where are the statistical studies? What was the methodology? Have these studies been duplicated" I mean WHERE is the scientific method?

Elizabeth said...

Anne & Melissa

Harry had NOTHING to do with the SOC which I personally consider a farce. To Harry every patient he had was different but special and if you meet others treated by him they will tell you the same story.

Every situation is different. The SOC seems to me to be nothing more than something money hungry therapists and doctors and surgeons can hang their hats on to keep charging everyone lots of money.

IMHO if one is transsexual one should get hormones first for feminization. I don't want to see some poor transsexual emotionally destroyed by being forced to present as a female when they are not ready physically, emotionally, and psychologically because if they do not they cannot get hormones.

It is simple for me. If you are transsexual then the thought of feminizing hormones is more important initially than getting to play dress up and if it is not then maybe one should step back.

Harry had a simple philosophy. Better one too many get surgery than one too few. It almost seems to me as an outsider that the gatekeepers are trying to protect against the pretend transsexuals when they should be worried about what is best for the transsexuals.

If some fool wants to grow breasts and has surgery and regrets it then the shrinks failed and free will is a powerful thing and I have no sympathy for the individual. That may be cruel but so be it.

Those of us that have walked this path regardless if we were 14, 25, 45, or 55 know a level of perseverance and courage that none of these shrinks will ever understand.

I better stop or I will get upset.

Melissa said...

Don't you ever stop saying what you feel is the truth, sweetie! You are truly, a breath of fresh air!

Thanks, and a really huge hug!
Melissa XX

Caroline said...

Your thoughts are those which have driven four decades of inner turmoil and rage after my early 70's rejection by my doctor!

What we have is totally absurd in so many ways and supports a whole raft of highly paid at the expense of a group of oppressed. this verges on a human rights issue.

I said this when I was finally forced to see a psychologist to get hormones 45 years late!

Caroline xxx

Gin said...

Elizabeth, it is perfectly okay to be upset about the system. It is massively flawed and we all become expert hoop jumpers by the end of it if we should be lucky enough to get something like what we need. I felt like the last three months with my therapist before she wrote a letter to my doctor were us simply running out the clock until she could be sure that she had followed the SOC to the letter. While I love her, she still frustrated me to no end because she would say "I'd love to write the letter now, but the SOC says..." and what it comes down to is that the SOC should actually be called the CMA for the therapists and doctors involved because it is all designed to help them protect themselves lawsuits.

It'll be a long time before any of this changes...


April said...


Under CAMH here on Ont. Canada they still require one year full time before hormones. There is a political correctness reason for this, however they will not hold it against you if you start hormones "early".

Unfortunately my GP having read their rules was totally unwilling to precribe them. As we have socialized medicine here I had to delist from her and seek a more understanding family doctor. It took me nealy eight months and drove me to distraction.

I have been on hormones now for about six months.



Elizabeth said...

I guess my feelings about shrinks therapists and doctors is clouded by my experiences with them. As a child they treated me like I was some degenerate pervert.

Dr. Person was nice but her study with Ovesey was not aimed at understanding transsexuals but at effeminate homosexuals and what she described as homosexual transsexuals or kids like me that pressed the issue as children. Harry diagnosed kids like me as Type VI with total psycho-sexual inversion. Basically I believed I was a girl and I did even though in strict medical fact I was not.

That single study has haunted transsexuals from the day it was published and it is flawed and a disgrace because it was not Research it was justification of personal opinions and prejudices spouted by certain individuals, Person included although she was a friend, that wanted to prove a connection between the so-called most intense transsexuals and homosexuality.

They missed the entire point of Harry's book and his life. A transsexual is not the gender between their legs. A transsexual is the gender between their ears. It is really that simple and gender is pre-programmed into us and it cannot be changed. It is part of our being and is the essence of what makes us human.

I guess I would be classified as a Research Engineer for most of my life with the added caveat I put my research into practical and sometimes very unpractical real-life application. If research is not impartial it will always be flawed. One can have a premise for one's research and a belief about what should result but the process involves both trying to prove yourself correct and trying to prove yourself WRONG. We thought of it as research integrity. I see absolutely none of that integrity when dealing with transsexuals. Everyone has an agenda and little has to do with helping transsexuals. They are more interested in proving themselves correct than the truth.



Anne said...

I agree with Melissa that yout perspective and willingness to express it, is a much needed breath of fresh air. As a relative neophyte to these discussions, I am constantly astounded by such revelations as those made by April, above, that CAMH still actually require one year RLE, PRIOR to HRT. I find that "requirement" to be BEYOND unreasonable as well as seemingly capriously cruel.

Again,I think the problem lies with the system of "health" providers. They are all basing their judgements and decisions on faulty data provided DECADES ago by researchers hampered and influenced by the political, academic and moral climates of their time.

I have yet to see ANY connection between homosexuality and trans-sexuality, and yet in todays culture and conversations, these are inextricably mixed and conflated.

Another area of unsubstantiated and yet again uncritically accepted "Conventional Wisdom" is the relationship or "sameness" of cross dressing and transsexuality.

Some transsexuals may 'cross dress' as part of their pre-op RLE, many cross dressers have NO, ZERO interest in "surgical conversion".

While many of your readers might consider this idea "elitist" or "hateful/bigoted/separatist", let me assure you AND readers that it is not. It is simply a reflection of REALITY. NOT MY reality, but simple empiracal, statistacally PROVABLE, reality.

I lay the responsibility for much of this confusion, mis-information and general mayhem wreaked on the lives of thousands of individuals directly at the feet of self interested "trans" activists and the LGBT self declared leadership.

Veronica said...

The clinic I worked through in Vancouver (Canada) seems to follow the SOC -- more or less. However, there is no expectation of doing RLE before you start hormones.

I saw my doctor several times over the course of four months. During that time, he was mainly doing medical tests, getting baseline lab levels, things like that. He was in touch with my therapist. At the end of four months, he started me on HRT, somewhat cautiously in my case (spiro first, later estrogen -- long story). I started RLE when I chose to, and I let my doctor know when I did. That started the countdown to surgery.

Curiously, I was "semi full time" as soon as I started HRT. I was going to school at the time, and I went as female. Instructors and fellow students were all really, really good, because I'm sure my presentation was, well, unpolished. But somehow I had no fear of it. It really helped me get ready for when I no longer presented as male at all, a few months later.

Anne said...

I am not sure all of your readers are aware of this, but just for the sake of general interest, I returned to my job after starting endochrine therapy and continued to mascarade as male for almost nine months, until I completed my employment contract.

Upon completion, I immediately sold my house, left my car and worldly possessions with a "friend", FINALLY shaved the hair from my face and relocated to the West Coast for my SRS.

My "transition" took place literally overnight on the long bus ride to California. I boarded the bus, appearing to be a somewhat effeminate looking young male, and disembarked a day and a half later as a reasonably presentable young woman.

I took care of the permanent removal of my facial hair during that long and painful recovery from the surgery which in my case took almost 7 months. Frankly speaking, it was just plain AWFUL.

Elizabeth said...


How old were you then if you don't mind me asking?

When I graduated from grad school in 1966 I went to work in about as testosterone filled place as one can think of in Houston. It actually was OK but I felt like a lone sheep at a wolves convention.

When I resigned in Houston I got on a plane and landed at Logan and flipped from boy to girl in a motel room because I could not do it at home because of my grandmother and went to another motel and paid cash while I got up to speed at my Uncle's company.

I was so scared but it worked out.


From your pic I am guessing passing was not a big issue even at school. I am assuming it was college.

When I was in college everyone in my dorm knew about me so I was androgynous but if my boyfriend visited I just flipped to girl and nobody batted an eye. I had to be careful because the scholarship I won was not all that happy when they found out I was TS so any complaints or bad grades could have cost me that and it was my independence at stake.

My best friend was a drag star in the Vancouver area in the 60's and early 70's.

Veronica said...

Elizabeth, this was college as a "mature student" (at 54) in 2008. Despite my having been a pretty boy in my younger days, I doubt that anyone in those first classes I took did not know I was transsexual. They were, however, all very supportive. I never got hassled in or outside class. I never had a problem using the women's washrooms. I heard correct pronouns. And I made friends, some of whom I'm still in touch with.

By the time I went full time for real that summer, it was a different story. Hormones helped. Knowledge helped. Confidence helped. If anyone clocks me now, I'm unaware of it.

Interesting that you had a Vancouver connection. :)

Elizabeth said...

She had arguably the greatest drag show ever. It ended up in LA and then Vegas. She left millions on the table to have surgery. I have seen her copy of the contract she rejected and I gasped at what they offered her.

One of her great lines was "I felt like a girl playing a boy so I could play a girl to get money to become a girl and they wonder why I am confused sometimes."

You look fabulous for your 50's by the way.

Veronica said...

Thank you!

Sibyl said...

Hi Elizabeth,

I'm Sibyl ,and here are my thought, such as they about this having been through the SOCs as they exist, and not sot long ago... let me see that would have been how many years? 2,,. 5... hummm, OK so maybe it's almost a decade back now....My God! Does time really pass that quickly?Funny it didn't seem that long ago! Anyway, having been through the process more recently than either you, Elizabeth or Anne, in my humble opinion, while the SOC does need tweaking, on the whole they are dead on the money! If anything, the SOC's are TOO loose!


Mind you, for the Type VI transsexual and for many of the type V , the SOC as written is nothing but a joke... For any women who solidly fits, the therapeutic role should be; Straight to hormones, then a “Real life Test” which is open ended and focused on you to getting your life together in your corrected sex so that when you reach the point where you have to have the surgery, because not having it is a stumbling block to your moving on. Then, and only then, do you get surgery...

Did I just contradicted myself?


You see, one of unintended consequences of the rise of the Information age is that while information is wildly available it is also highly diluted... So much so, that deciphering truth from the bunkum has become way more difficult not less! This holds true for the learned just as much as it does for the unwashed masses and no where is that more true than on the subject of the transsexual/transgendered...

So what has that to do with the SOC?

Simple... with the assertion of gender-theory over hard science and the net flooded with “gender-identity-politics,” there are now millions of barely choate voices shouting utter and total nonsense and the combined sound is deafening! Into this cacophony of madness stumbles two very different but equally confused and desperately needy groups of people.

Those with issues about their social gendered roles, and those with issues of mind body sexual incongruence... Would seem to be an obviously not the same, but you would never know it from the body of bad science data... The result of all this is that those with issues about how they dress or what is expected of them socially are now conflated with those with issues about having minds and bodies that are no two different tracks headed in two different directions!

Looking back it all seems so clear, but trust me...looking the other way in the here and now it is mind-boggling! What is worse most of the professionals/gatekeepers are so inundated with the BS that you have a situation where tons and tons of folks who should be getting help dealing with their social issues are being surgery tracked, and these folks are legion!

Enter the SOC and all those on the surface seemingly stupid requirements for the patient to actually get a taste of life as the other sex is to save their lives before they do something they cannot take back, like stepping off a cliff and in this context, even the issue of withholding hormones makes perfect sense! Because without it you would have even more folks getting a contact high from the hormones and in a state of high delusion rushing themselves and their loved ones nilly-willy like the lemmings they are to utter ruin! Better they get a chance to see, albeit it though an off viewing, of some of the realities that will be theirs if they proceed...

Maybe one of these days when hard science catches up and the gender theorists go the way of the comparative biologists the SOC's can be tossed... but until then, they are all that stands between the hordes of men and women who do need help but of a vastly different nature than what we need(ed)


Elizabeth said...


I think that old political statement that goes something like "You cannot legislate against STUPID" comes to mind.

I tend to agree with most of what you have said. When I watch, read, and listen to people parrot almost word for word what is expected of one to be classified as transsexual it gives me the creeps sometimes. I often think maybe I am in the middle of a Stephen King novel and the people have been taken over.

Dr. Benjamin believed that it was better that one too many get surgery than one too few.

A Psychologist?

Good comment.

Sibyl said...

Thank you Elizabeth!

Coming from such a gifted writer I consider those words of high praise... and I must say, I too agree with the precept/ "you cannot “legislate against stupid,” But... at the same time, there is a social duty to protect the truly stupid if one can... After all, you too will be paying the price for their stupidity, due to the very the nature of stupidity! It is the penultimate loose loose proposition!

A few years back< I was twice afforded the opportunity to interact with the patients of the best genital reconstruction surgeon in the world... During that time I met the better part of a hundred “women. With such numbers and in such a self -selected group, one would likely assume the majority, if not all would be headed towards the goal of normality as women. What with that whole woman and vagina thingie? If one did, then one was seriously wrong!

For every ten patients, mind you, these are patients getting genital corrective surgery, there were no more than one actually tracked towards the goal of womanhood...What the other nine were tracked towards... to be honest, I really don't have a word for it,, but whatever, it sure ain't womanhood...! I mean what do you call the “dickless dad” or the sailors with boobs, or a professional Viagra downing she-male hooker (“she” was the anomoly as she was there for another round of cosmetic work, no way is “she” cutting off the money maker.) Bottom line, no matter however you sliced it. A full nine tenths of his patients are simply not and never will be women!

So, do we need to protect these patients from themselves? Um, no...They're adults, they and their loved ones are just going to have to live with their choices good or bad. But, that said, when you get such numbers they create their own “gravitational field ...”(sorry I could not resist, given your back ground!) Like any large mass they draw others into their orbit and next thing you know, you have what you have now... On college campus' cross the land. Butch lesbians are swarming towards becoming “men” rather than face the social pressures of being manly women in love with other women. Likewise, you have all these men attracted to the trappings of femininity as well as being attracted to women, but with no social outlet, and the pull from those who went before doing the misery loves company thing... They too are drawn in towards being “women.”

Neither group has a clue, neither is capable of actually getting there cause as you well know, you can't really change your sex! Something they will not, and cannot realize until way too late to put the genie back in the bottle... Sadly, it is for these people and not those with “true transsexual” issues that the SOC was written.

So yes, we do need the SOC and I wouls say we actually need to toughen it, but we also need a rewrite to offer an outlet for the “true transsexual.”


Elizabeth said...


I cannot disagree.

At least they hopefully cannot procreate.