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Before I lose my focus again, I just wanted to get this out there.
BREASTS
My thoughts about them. So unfiltered rambling, here we go.
Though mine are just forms, I have to think what is the difference between my fake breasts and a woman who gets breast augmentation. Do they have to get a psychological clearance them? And another thought about FTM, do you need to get medical approval to remove your breasts?
Ask your health insurance about how the Standards of Care apply according to their coverage. Last time I checked one needed a psychologist to write a letter supporting one’s medical need to start HRT, two letters from two different psychologists supporting one’s medical need for BA, FFS and GCS. I have a trans man friend who recently removed his breasts. I would guess he had two supporting letters from two psychologists but it never came up to ask him. Your health insurance would be the opinion to listen to on this.
Thank you for the responses. Now what bothers me about all this.
Why?
Woman and Men, who are not trans can make decisions on body modifications as they please. Tattoos and body piercings or even enhancements of body features without psychological referrals.
Bottom line, I go to counseling to help myself make competent decisions. Not to get someone’s referral cause they have been convinced what I say is true.
True equality, I am a person who knows who I am and how I want to see myself. I don’t believe I need to convince anyone of who I am. This is what I struggle with. All my life I have been trying to convince myself to be something I knew I wasn’t, but here I am trying to convince people that I am who I am. Trading one act for another!
Just a rant, maybe you feel the same way or you don’t!
To an extent I agree with you. However, anything that is considered an elective surgery, or cosmetic and not medically necessary, insurance will deny. You cantc get a facial reconstruction surgery with insurance money unless it is medically needed for your health somehow, such as a burn victim. Not if you just want to look prettier. You will be denied. Unless you are paying with your own money, then you can get any surgery you want if you can find a doctor that is willing. The problem is that trans people aren’t always recognized as needing it medically, even though it is a necessity for our mental health. That’s the problem I have.
Hi Jasmine,
Ugh – late to the party per usual…
This isn’t always the case, and as Xelyn illustrated, as cis men and cis women might make changes to their bodies based on a cosmetic basis, whereas trans men and trans women might make changes to their bodies based on what’s deemed “medically necessary“. Where I differ in opinion to Xelyn (and the much of the medical establishment) is what is viewed as medically necessary – perhaps a better term would be “gender congruence” (imho), and probably should be approached as such, since both men and women come in all shapes, sizes and colors.
Also, ‘gatekeeping’, though mostly used as a negative (and is “usually” limited to social and insurance models), does serve a useful purpose. It helps to establish the standards (outlined by others here), as well as ensure those wishing to transition don’t have any underlying medical or phycological conditions in need of attention first. In this way, the best possible scenario exists to build on a solid foundation of wellness that will make one’s journey all the more successful.
Hugs, peace and much love,
MJ
Jasmine,
I hear you about the gate keeping we have to go through. It’s a lot. It’s also more cost, more time and can be frustrating. Regardless of having my letter from my psychologist and having had my psychiatrist diagnose me with gender dysphoria before that I was denied HRT by the first medical doctor I approached. It can be exasperating. What kind of problems are being thrown at you? Any roadblocks in your transition or is this just about feeling the Standards of Care are unjust?
I found some snippets from the Standards of Care to try and have it answer your “Why” question:
“The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people 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.”
“As for all previous versions of the SOC, the criteria put forth in this document for hormone therapy and surgical treatments for gender dysphoria are clinical guidelines; individual health professionals and programs may modify them. Clinical departures from the SOC may come about because of a patient’s unique anatomic, social, or psychological situation; an experienced health professional’s evolving method of handling a common situation; a research protocol; lack of resources in various parts of the world; or the need for specific harm reduction strategies. These departures should be recognized as such, explained to the patient, and documented through informed consent for quality patient care and legal protection. This documentation is also valuable for the accumulation of new data, which can be retrospectively examined to allow for health care – and the SOC – to evolve.”
And just one more exerpt:
“The SOC are not intended to limit efforts to provide the best available care to all individuals. Health professionals throughout the world – even in areas with limited resources and training opportunities – can apply the many core principles that undergird the SOC. These principles include the following: 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, when present; become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of treatment options for gender dysphoria; match the treatment approach to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria; facilitate access to appropriate care; seek patients’ informed consent before providing treatment; offer continuity of care; and be prepared to support and advocate for patients within their families and communities (schools, workplaces, and other settings). “
Here’s a link to the SOC copy I took these from:
Okay so if you’ve not gotten too flustered with the exerpts and have made it this far I want to tell you an answer to your question from my perspective. I think what’s going on is the psychological, health insurance and medical fields are trying to give us the best chance against transphobia. I think the psychological field has us in their Diagnostical Study Manual, DSM, in order for insurance companies to consider our medical needs as actual medical needs. Overall I think the medical field wants to make sure it will be paid for services rendered. I also think the medical field wants us to be as successful in our lives as possible post surgeries. And voila, there’s a Standards of Care! Honestly, once the hoops have been jumped through you might just forget about it like I have.
We have some great information from this thread, and I notice that no matter how vague I try give a chance for our non TG members to participate, I am striking out here. And you all have been respectful not to comment from a non transgender view. Which brings me to my next issue I deal with.
How do you accept standards made up from the medical field based upon observational theory?
I just feel, that many I chat with struggle to validate who they are. And in my time with CDH and TGH, I recognized a consistent trend of trying to reconcile with memories of our child hood.
A little background here on this question, I question how professional those who provide care for trans people and those trans people that blame the medical community for their failed transitions.
Jasmine,
I just accept medical transition assistance and be thankful I’m getting any. I look the other way.
I wish my general practioner would have more credentials than a one semester class on us. I wish they would actually know other transition medical professionals. I mean, at least have read their research! I wish there were much more research! I’m tired of having to find and vet all of my medical specialists for transition. I’m a laborer how the hell am I supposed to know medical stuff?! It’s like they pin all of this information I need to know like a hatchet in my back even though I’m paying them for medical advice(and I think they offer almost none so why am I paying them). That’s like if I want to go for a drive in my truck I better research how rubber is made, the history and proper formulation of steel and how those materials form a tire. And oh yeah, don’t forget to know what Greek genious invented pnuematics so we can have the technology of tires at all.
Frustration. Knowing what I want is easy. Getting what I want…now that’s the trick!
On self-validation:
I don’t have a problem anymore with proving my gender to myself. Sometimes I think how did my psychiatrists not see it? How did he see it and then not tell me he did? I can’t remember even talking to him about gender issues. Maybe it’s the full acceptance I get from my partner. Maybe it’s the two decades of waiting for medical transition? The time gave me reasons as I read, hoped and dreamed. I don’t look to others for proving anything about me.
awesome question Jasmine. Tiff and Dasia both answered Qs I haven’t even thought of. TAs you know my body is different and already have Cs and most are asking the question why is she in this conversation. Most would love Cs.But I also have a 42 inch chest measurement so they barely protrude and have little definition. Being at 15 months I am almost finished with rapid growth and am considering augmentation for the “Girls” I desire. In reading this I will most definitely ask some different Questions.
Thankz girls Huggz Tracee
Hi Jas
I’m Maxine and I’m im cos, my partner is FTM and we live in England. In England you have to have medical approval to have top surgery. They check your metal capacity to make the decision etc.
It’s very long winded and can take a long time. He’s yet to have his surgery, and he’s going private and still has to have medical approval!
Whereas you can go to a private surgery to have breast enlargement and from what I’ve heard it’s pretty easy to get the go ahead for that!
We so live in a backward world.
[quote quote=32653]To an extent I agree with you. However, anything that is considered an elective surgery, or cosmetic and not medically necessary, insurance will deny. You cantc get a facial reconstruction surgery with insurance money unless it is medically needed for your health somehow, such as a burn victim. Not if you just want to look prettier. You will be denied. Unless you are paying with your own money, then you can get any surgery you want if you can find a doctor that is willing. The problem is that trans people aren’t always recognized as needing it medically, even though it is a necessity for our mental health. That’s the problem I have.
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Absolutely this and I’m currently going through the same thing myself.I wore breast forms for many years. I dealt with them. But over time, I felt the need to be as natural as possible. I learned that while being a military veteran that the VA would support HRT, medically and mentally. I went through a lot of counseling and therapy and was prescribed the meds to develop breasts. Its taking time, but I have natural breasts now. They’re not as large as I prefer, but I’ve waited this long, I can wait longer.
I support anyone, whether forms or natural. If you present yourself in the female gender well, I’m not going to be critical about your actual breasts. Most transwomen do a great job looking their best. Thumbs up to you all.
Thank you Tiffany. I’m in IT in the medical field at a University and can say your words are spot on as both an out employee and a patient. My providers are staunchly set on adhering to WPATH standards and have shown a conservative bias to accepting results that were outside the standards by even small margins and ended up having to take my own risk at changing dosages to prove I needed a change. I’ve asked and the only research anyone is conducting is related to hair removal. As you said, it’s because it’s something that physician wanted to study and not necessarily for transgender specific reasons. I’m not sure the study even got off the ground as I was told I would get a call when they started training residents and they needed test subjects, but we’ll see as the new class comes in soon. I applaud them for their efforts at creating the clinic and providing a safe space for transgender people to find care, but I can’t go further in praise. I won’t say more out of my own concerns of ramifications, but I can tell you that you are not the only specialty physician out there who is trans and is fearful for known good reasons. It’s a tragedy and I don’t know where to turn to to make a difference. I would have hoped the public good would be enough to do more particularly in light of how visible our plight is right now. My fear is that this candle too will burn out quickly, like many of us, and the opportunity for something wonderful will be lost.
Hi Tiffany,
I’m excited to hear about your professional medical opinion on the state of trans, non-binary and gender non-conforming medicine! It’s interesting to read your thoughts. You mentioned there aren’t very many out trans doctors in America. I know of a couple, from having watched “I am Jazz”, and from my research. There’s Dr. Marci Bowers of San Francisco, Dr. Christine McGill of Philadelphia, and Dr. Danielle Weitzer of New Jersey. I’m interested in any others you’ve found.
Talking about the state of trans medicine in the UK:
https://onlinelibrary.wiley.com/doi/pdf/10.1002/tre.550
Also, I found this one discussing America:
https://www.amsa.org/advocacy/action-committees/gender-sexuality/transgender-health/
Here’s an article with helpful resources:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32423-1/fulltext
Trends are changing all the time. I understand that there aren’t many doctors in our communities. Most Trans folx, not sure about NB and GNC folx, are four times more likely than others to make less than $10,000 a year in the US. With marginalization that steep, I’m proud we have some who’ve made it through med school! I’ve actually found some in Business as well such as Jennifer Pritzker and Marissa Mayer. The Wachowski Sisters also made it big time in Hollywood. There are many others. I’ve noticed that the successful ones seem to be those who used their “male privilege” to get their education, career and savings and then they transitioned or they transitioned young giving them “passing privilege”. There’s one more link I want to give you to help you find some hope. Here in MN Andrea Jenkins, a trans woman of color, interviewed over 200 of us. The stories were on video in their own words. There’s many perspectives and I think you’d enjoy.
https://www.lib.umn.edu/tretter/transgender-oral-history-project
Best,
Dasia
Tiff,
I wish there were more trans, nb and gnc doctors, too, to help us through medical procedures! I also wish there were much more medical research for our doctors and us to use to make our realities better! Thing is the proportions are off. Trans, NB, and GNC folx are a mere 1-2% of the human population. We’re not all wanting to be doctors. I’m into Interior Design and Construction, for example. We need to trust and develop our cisgender allies. All but one of my doctors have been cisgender folx. The medical teams are trying in some parts of the world.
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