The "T" Party. - Page 35

TodKurtis · 03-05-2013, 10:48 AM

It sounds like he's probably going to an endo at an informed consent-based clinic. They're fairly new so not standard practice yet, and there aren't many of them around.

Generally it is considered a good idea to have therapy during transition for support, but he may have other sources of support (such as very close friends, local trans community, etc - it may be that he hasn't told his family about them if they disapprove; my family definitely doesn't know most of my trans friends, because they tend to try and chase them off). It may also be that he can't afford therapy, or couldn't afford it without involving his parents because he's still on their health insurance and they would try to push him towards a therapist that would try to 'cure' him, and he was urgently in need of moving forward with his transition.

Generally, I would say - don't worry about it. It would be ideal for him to have support, but the truth is that while many trans people do feel that they needed the support of their therapist, there are many others who don't see their therapist as a source of support at all and just go through the motions to get approval for hormones, etc. It is not as much of a necessity as some people make it out to be. He may be able to find a free counselor at his school to talk to if he needs it (I know my state uni provides them, I'm not sure what the norm is for community colleges) but I think the best thing to do is assume that he knows what's right for him and not panic about it. Everybody experiences transition differently, so there's no single 'healthy' way to go about it, just like any other major life decision.

Nonny · 03-05-2013, 02:23 PM

Quote:

Originally Posted by Kitty Pryde

So if I am out of line asking this here, please let me know. A friend has a family member who came out as transgender late last year. He is not yet living as male. I think he is 19, going to community college, living in a mildly disapproving household. he doesn't have any transgender friends or mentor type wiser folks. My friend is trying to be as supportive as she can be, but she is really worried because he found a doctor to start him on T injections without any therapy/counseling/advising/educating/anything about feelings, beliefs, expectations, etc. now whatever changes he will go through, physically and life wise, he has no emotional/medical/mental health support for. Is it usual, or good practice, to do that? What do you think this young man could do for a healthier transition?

This is a newer practice. Older standard of care (which is changing) requires therapy and, I believe, living as the preferred gender for a certain period of time before hormones. Newer theory is that it's pretty hard to live as preferred gender without hormone support, and that most people don't come to that decision lightly; I have actually known a number of younger trans people who have gone on hormones without therapy.

Which... honestly, for them? They said that they found a lot more support through online groups. Depending on where you live, trans-friendly therapists can be difficult to find (and depending on what else informs your identity, it can be even more difficult -- a disabled trans queer POC that also needs a pro-feminist and sex-positive outlook is going to probably have a more difficult time finding a therapist that "gets" them and their needs). Intersection is harder than it would appear; most of my friends had good luck finding therapists to help with the "regular" issues, or the trans issues, but not both. My ex, who is now living in SF (*waves to Robert if he's reading!*) has had the best luck of everyone I know, and well, SF is a little more up-to-date on progressive issues.

So, I wouldn't actually be too worried. Your friend's doc probably knows that it's really hard to find a trans friendly therapist, a therapist that understands whatever issues exist on top of that, and a therapist that meshes personally. Even if the therapist is good at all these things, it's entirely possible that they will have an approach that just does not jive with you. (My psych is this way. She's great with meds, but her attitude towards therapeutic stuff? It's very positive-thinking focused and I find it condescending. If I could just think it away, I would have done that already.)

I think it is a good thing that his doc isn't tying his treatment together with therapy. While therapy isn't bad, as I've just said

there's barriers (plus therapy is not always covered by insurance!), and many of the trans folks I know have done great with online or RL support groups, which allowed them to meet other trans people and talk to people who are going through or have gone through the same things. Some of the folks I know whose doctors insisted on therapy weren't able to get hormone treatment because they weren't able to afford the therapist or they couldn't find one that was trans friendly or that meshed well with them.

You say that your friend is going to college -- is there a trans support group on campus? Community colleges sometimes still have those resources!

Kim Fierce · 03-06-2013, 02:14 AM

Or at least an all-inclusive GLBT group on campus should be common, and hopefully find trans support there. But I have heard that the extensive therapy is being seen as not always necessary myself.

DancingMaenid · 03-06-2013, 06:29 AM

Quote:

Originally Posted by Nonny

I think it is a good thing that his doc isn't tying his treatment together with therapy. While therapy isn't bad, as I've just said

there's barriers (plus therapy is not always covered by insurance!), and many of the trans folks I know have done great with online or RL support groups, which allowed them to meet other trans people and talk to people who are going through or have gone through the same things. Some of the folks I know whose doctors insisted on therapy weren't able to get hormone treatment because they weren't able to afford the therapist or they couldn't find one that was trans friendly or that meshed well with them.

I agree with this.

In theory, seeing a therapist can be a good idea. But I'm not comfortable with it it being a requirement, and in practice, it can be more of a barrier or a hassle than anything else. It can be very hard to find a therapist who's not only sympathetic toward trans people, but also has training and experience working with them. For example, I had a therapist for a bit who was extremely sympathetic and tried to help me come to terms with my gender identity, but I could tell it just wasn't her area of expertise, and she really didn't have any feedback or suggestions that helped.

Also, because therapy is often a requirement for treatment, that can hinder a therapeutic relationship between the therapist and patient. I think a lot of trans people feel like going to a therapist is something where they have to go through the motions, and that they have to say the "right things" so that the therapist will believe them. And sadly, sometimes this is true.

So I think gender identity-focused therapy can be a wonderful idea for people who are starting to think about transitioning, or who are coming to terms with their gender identity. But the current model doesn't really supply that.

Guardian · 03-06-2013, 08:33 AM

I'd have to agree that therapy can be a hit-or-miss that can even raise more problems than resolve them. For instance, my boyfriend attempted therapy and the therapist began questioning if his history of sexual abuse is the reason why he is trans. Some people may want to investigate that kind of questioning, but to others it is dismissive and offensive - (are straight survivors of abuse asked if the abuse may have cause them to become straight?)

Unfortunately, there's a history of therapists being used to try cure trans or homosexual people. I can't say how prevalent those therapists are vs ones that would actually not try to convert anyone, but I'm aware of this bad reputation. It's the reason why I myself am nervous about discussing my homosexuality with a therapist, and the reason why my boyfriend is nervous about talking to doctors or counselors or others. Also, he just plain has an unbelievably horrible record of experiences - no one would help him with his anxiety attacks, for instance. Ugh.

Kim Fierce · 03-07-2013, 05:52 AM

I'm not trans, but my experience with therapy is mediocre at best. I have learned more by talking to people I have met, or online, who either go through the same things or can relate!

Mara · 03-07-2013, 02:17 PM

Therapy can help with the transitional period, but there's a long, nasty history of quacks with harmful theories acting as gatekeepers. The new Standards of Care and most other modern documents have moved mostly to an informed consent model, because required therapy turned out to do more harm than good overall due to bad therapists.

So, it'd be nice if he had a therapist to help out, but it's not mandatory. As long as nobody was pushing him into this and lying to him about the consequences, it's all pretty ethical.

Medievalist · 03-07-2013, 09:02 PM

Quote:

Originally Posted by Mara

Therapy can help with the transitional period, but there's a long, nasty history of quacks with harmful theories acting as gatekeepers. The new Standards of Care and most other modern documents have moved mostly to an informed consent model, because required therapy turned out to do more harm than good overall due to bad therapists.

Before anyone consults any therapist, I'd suggest referrals from other medical professionals, verifying licensing and training, and if at all possible, a personal referral from a patient.

There are a lot of less than ethical people out there. A lot.

Kitty Pryde · 03-12-2013, 04:52 AM

Thanks for all the thoughts, peeps. Much appreciated. One thing that my friend has noticed, and her nephew has stated many times, is that he is isolated, doesn't have support or help on this issue, and feels very lost and hopeless in general. His family is not quite supportive, but not rejecting him either. What you say about therapy makes sense. I am going to ask some local guys if they can recommend a social group or cool supportive type person for him.

Becca_H · 03-18-2013, 03:21 AM

Agree with basically everything of the above. Therapy is a necessity, but it can come from anyone or anything. In early transition, supportive friends are worth a million times what a therapist can be. And if a therapist is sought, absolutely pick them carefully. A routine visit to my school counsellor about something completely unrelated turned into her trying to convince me to detransition, because, you know, "society" didn't "approve" of me.

There are many good trans-experienced counsellors out there, and many will do ad-hoc email/telephone/instant messaging support (I can recommend one if anyone wants to PM me). And I would recommend that one if these is found.

The problem is that transitioning is for life, but support for it only really happens at the start. There are support forums for trans people, Facebook groups, etc. But as people progress through transition, they often identify less and less as trans, and have less and less to do with the demographic.

An example I can give from my own personal experience is this. When I transitioned, I knew this would affect me having kids. It was a problem, but not the biggest problem I had at the time. Ten years later, not being able to have kids is a big problem for me emotionally. I have days where knowing I won't ever get pregnant or give birth to a baby can really get to me. I'm also pretty much stealth, so hardly anyone knows I'm trans and the friends I can talk to about this are very low in number.

When I was under psychiatric assessment (or whatever it is they like to call it) I often asked the psychiatrist about adoption, and the success rates trans people have. Did he know anything? Nope, because he never saw people after he considered them "fixed". But I happen to still see a medical practitioner who works with trans people well, well past the time they're considered post-transition. I asked her how many trans people adopt. She said "most of them" and went on to tell me how it's not a problem, and I generally felt much better. I probably couldn't have got that support from a trans forum with people (mostly) in early transition. And likewise, while many women experience infertility problems, I can hardly go to a support group for it and say I can't have a baby because I'm trans - I'd likely get evil stares for it.

So while a therapist isn't necessary, in 5-10 years time, it might be good to have someone who he can confide in, who knows him, who has experience with trans people pre, during, and long post-transition who he can talk to. Because stealth is a very lonely place sometimes (as is the constant fear of being read or outed, but that's another thing).

03-06-2013, 02:14 AM	#853
Kim Fierce Attack me with everything you have. Join Date: Apr 2011 Location: Indiana Posts: 1,100	Or at least an all-inclusive GLBT group on campus should be common, and hopefully find trans support there. But I have heard that the extensive therapy is being seen as not always necessary myself. __________________ No Turning Back, YA Contemporary Watch the book trailer Amelia's Revolution --steampunk short "Two-Spirit's Red Road" 6-09-13! The Divide: Uprising YA Dystopia The Divide: Unity -- in progress My Secret Pain --YA short, 8-?-13

03-06-2013, 08:33 AM	#855
Guardian Rainbow Laser Princess Join Date: May 2010 Location: a land of unicorn glitter Posts: 3,313	I'd have to agree that therapy can be a hit-or-miss that can even raise more problems than resolve them. For instance, my boyfriend attempted therapy and the therapist began questioning if his history of sexual abuse is the reason why he is trans. Some people may want to investigate that kind of questioning, but to others it is dismissive and offensive - (are straight survivors of abuse asked if the abuse may have cause them to become straight?) Unfortunately, there's a history of therapists being used to try cure trans or homosexual people. I can't say how prevalent those therapists are vs ones that would actually not try to convert anyone, but I'm aware of this bad reputation. It's the reason why I myself am nervous about discussing my homosexuality with a therapist, and the reason why my boyfriend is nervous about talking to doctors or counselors or others. Also, he just plain has an unbelievably horrible record of experiences - no one would help him with his anxiety attacks, for instance. Ugh. __________________ "Remember to always be yourself. Unless you suck." - Joss Whedon

03-07-2013, 05:52 AM	#856
Kim Fierce Attack me with everything you have. Join Date: Apr 2011 Location: Indiana Posts: 1,100	I'm not trans, but my experience with therapy is mediocre at best. I have learned more by talking to people I have met, or online, who either go through the same things or can relate! __________________ No Turning Back, YA Contemporary Watch the book trailer Amelia's Revolution --steampunk short "Two-Spirit's Red Road" 6-09-13! The Divide: Uprising YA Dystopia The Divide: Unity -- in progress My Secret Pain --YA short, 8-?-13

03-07-2013, 02:17 PM	#857
Mara Clever User Title Join Date: Sep 2009 Location: United States Posts: 1,889	Therapy can help with the transitional period, but there's a long, nasty history of quacks with harmful theories acting as gatekeepers. The new Standards of Care and most other modern documents have moved mostly to an informed consent model, because required therapy turned out to do more harm than good overall due to bad therapists. So, it'd be nice if he had a therapist to help out, but it's not mandatory. As long as nobody was pushing him into this and lying to him about the consequences, it's all pretty ethical. __________________ I can never remember to update this signature.

Thread Tools
Show Printable Version Email this Page
Display Modes
Linear Mode Switch to Hybrid Mode Switch to Threaded Mode

03-05-2013, 10:48 AM	#851
TodKurtis New Fish; Learning About Thick Skin Join Date: Feb 2013 Location: USA Posts: 5	It sounds like he's probably going to an endo at an informed consent-based clinic. They're fairly new so not standard practice yet, and there aren't many of them around. Generally it is considered a good idea to have therapy during transition for support, but he may have other sources of support (such as very close friends, local trans community, etc - it may be that he hasn't told his family about them if they disapprove; my family definitely doesn't know most of my trans friends, because they tend to try and chase them off). It may also be that he can't afford therapy, or couldn't afford it without involving his parents because he's still on their health insurance and they would try to push him towards a therapist that would try to 'cure' him, and he was urgently in need of moving forward with his transition. Generally, I would say - don't worry about it. It would be ideal for him to have support, but the truth is that while many trans people do feel that they needed the support of their therapist, there are many others who don't see their therapist as a source of support at all and just go through the motions to get approval for hormones, etc. It is not as much of a necessity as some people make it out to be. He may be able to find a free counselor at his school to talk to if he needs it (I know my state uni provides them, I'm not sure what the norm is for community colleges) but I think the best thing to do is assume that he knows what's right for him and not panic about it. Everybody experiences transition differently, so there's no single 'healthy' way to go about it, just like any other major life decision.

03-12-2013, 04:52 AM	#859
Kitty Pryde i luv you giant bear statue AW Moderator Join Date: May 2008 Location: Lost Angeles Posts: 8,864	Thanks for all the thoughts, peeps. Much appreciated. One thing that my friend has noticed, and her nephew has stated many times, is that he is isolated, doesn't have support or help on this issue, and feels very lost and hopeless in general. His family is not quite supportive, but not rejecting him either. What you say about therapy makes sense. I am going to ask some local guys if they can recommend a social group or cool supportive type person for him.

03-18-2013, 03:21 AM	#860
Becca_H Where am I again? Join Date: Jul 2010 Location: United Kingdom Posts: 523	Agree with basically everything of the above. Therapy is a necessity, but it can come from anyone or anything. In early transition, supportive friends are worth a million times what a therapist can be. And if a therapist is sought, absolutely pick them carefully. A routine visit to my school counsellor about something completely unrelated turned into her trying to convince me to detransition, because, you know, "society" didn't "approve" of me. There are many good trans-experienced counsellors out there, and many will do ad-hoc email/telephone/instant messaging support (I can recommend one if anyone wants to PM me). And I would recommend that one if these is found. The problem is that transitioning is for life, but support for it only really happens at the start. There are support forums for trans people, Facebook groups, etc. But as people progress through transition, they often identify less and less as trans, and have less and less to do with the demographic. An example I can give from my own personal experience is this. When I transitioned, I knew this would affect me having kids. It was a problem, but not the biggest problem I had at the time. Ten years later, not being able to have kids is a big problem for me emotionally. I have days where knowing I won't ever get pregnant or give birth to a baby can really get to me. I'm also pretty much stealth, so hardly anyone knows I'm trans and the friends I can talk to about this are very low in number. When I was under psychiatric assessment (or whatever it is they like to call it) I often asked the psychiatrist about adoption, and the success rates trans people have. Did he know anything? Nope, because he never saw people after he considered them "fixed". But I happen to still see a medical practitioner who works with trans people well, well past the time they're considered post-transition. I asked her how many trans people adopt. She said "most of them" and went on to tell me how it's not a problem, and I generally felt much better. I probably couldn't have got that support from a trans forum with people (mostly) in early transition. And likewise, while many women experience infertility problems, I can hardly go to a support group for it and say I can't have a baby because I'm trans - I'd likely get evil stares for it. So while a therapist isn't necessary, in 5-10 years time, it might be good to have someone who he can confide in, who knows him, who has experience with trans people pre, during, and long post-transition who he can talk to. Because stealth is a very lonely place sometimes (as is the constant fear of being read or outed, but that's another thing).