The Harry Benjamin Standards of Care, and their application in India

lana · 2016-09-17T14:41:03+00:00

Hi everyone! I'm a 30 year old transwoman from South India. I have tried to subtly change my outward appearance for sometime now (longer hair, piercings, mor...

Deepa

lana basically these ppl follow WPATH guidelines, if you want to make your case easy for physiatrist then going RLE in first meeting itself will help you alot, second thing they worried about is your future and support from family you have to make them feel that your independent, strong and that you can handle yourself well in life and you don't have suicidal tendencies, if you can assure this much then nobody can stop you from getting certificate.

One more thing, you have to make affidavit and get notarized that YOU are starting transition to female and nobody is pressuring you to do all these like that, this will come in handy if you get in any trouble while transitioning like police checking while driving or for banking etc

lana

yashika_1989

Hi Yashika,

I also go to NIMHANS but a Dr Suresh. Similar to yours, I have his students assessing me. I have been going for six months now, and also did the RLE and have met them 4-5 times. The sessions have established how I really feel, my dysphoria and everything else, but yet they are asking me to wait 6-8 months more. I cannot understand why.

I completely agree on HRT before going out as a woman. I asked the Doctors as well, and that was their answer: "so I can see how society treats a woman." But I would be a guy dressed as a woman - which is VERY different. Nevertheless, I still did it. I am not sure if I should change psychiatrists in the same hospital... considering the other doctor might feel offended etc. My next session will only be in Jan, 2017. I am just waiting and waiting indefinitely
?

Deepa
Hi Deepa, OK thank you ? I figured they were for SRS, but that is at least two years away for me.
I did the RLE as the counselor asked me to, I even offered to show him the pictures I had taken. But apart from that, I dont know what else to do. Right now, I just want to begin HRT, and I am being made to wait so long even for that! :\

iamcapricious
Hi Nandini, Thanks! Will check Victoria Hospital. Could you remember the names of the doctors? It would really help! ?

Thank you all
xx
Lana

Deepa

yashika_1989 body checking is normal, how can Dr be sure what's down there in these type of cases, there may be intersexual, or testicles might not be there, or small penis , breast development etc.. there are lot of things to examine. So it's easy for them to get idea once they have a look, don't be shy with Drs this is there profession they would have seen 100s of genitals ?

Deepa

Deepa @lana you can start seeing other doctor as per me, because for SRS you need two certificates, if you have to wait for one certificate for one year then for second you may have to wait another year from another Dr. So it will be good if you start looking other Dr right now so that you can save time

yashika_1989

lana I am really sorry to hear that. Yeah, if you feel that the psychiatrist attending to you is not doing his best or have any concerns with him, you should raise it with the doctor. I remember that I got the letter after 6-7 months and I had raised a concern about the way he used to take the session. That's a different thing that changing the psychiatrist may end up adding more months for further evaluation. I guess you should talk to your present psychiatrist and make him understand that it's been years since you have had this decision and he can see how sure and determined you are about this.

iamcapricious

@lana i will check in my certificate & let u know 2mrw.

lana

iamcapricious Hi Nandini, I don't mean to be impatient, but just wanted to check if you maybe managed to check the doctors name you were talking about, in Victoria Hospital? ?

Also, I read the WPATH. "The criteria for hormone therapy" starts on page 35 of the PDF, and there isnt even a single mention of Real Life Experience or anything like that. It simply states that a thorough and full evaluation must be done, before recommending hormones based on informed consent.

Why then are my doctors still insisting on RLE, and on waiting more 8 months after already meeting and establishing my case for full 6 months now? ? Is there anything you can infer? Would really help!

Honey Hi Honey, thanks for the link!! ? Where was the part about RLE that you read? I didn't see it

Honey

WPATH STANDARDS OF CARE VERSION 7 2011

There is no Real life experience and psychotherapy is not a must esp above 18yrs
If the patient has self medicated then the physician must immediately give treatment to prevent substance abuse and harms of self medication
Hormones or surgery or social transitioning is completely your medical ethical choice to safeguard interest of transexual gender non conforming and transgender
Doctors cannot make a decision for you if ur gender dysphoric or cannot deny treatment......u need to be proved mental in court if elsewise first

iamcapricious

Honey Thats a huge document to read, can u please let us know the page number where the RLE mandate has been debunked. I want it to easy for everyone to read the relevant information.

Sunny

@Honey can u please give us a link to WPATH STANDARDS OF CARE VERSION 7 2011
here ?

Honey

http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=3926

Honey

I wish i could upload the pdf file

sameera38

lana

Dear Lana,

The RLE is a mandate according to the 7th edition of WPATH guidelines only for patients deciding to undergo gender reassignment surgeries. It's not applicable for patients planning to start HRT. Hormone therapy is a potentially reversible phenomenon and not the GRS. Hence RLE is a mandate according to the expert consensus of the WPATH.

The previous editions of WPATH (version 6; 2001) had recommendations for RLE even for HRT too. This is not practical for trans commnity. So, if you mental health professional is confused about this, please show him the relevant documents to refer before he makes his standard of practice.

We need to have a take on RLE necessities in Indian context. As many working populations (educated middle class transgender people like you and me) will face extreme amount of social discrimination and harassment if it's made compulsory. This may not be a great trouble for the trans girls living as a community (I hope you got my point where am directing) and trans men who are already living in their gender confirmatory roles.

lana

yashika_1989 Thanks Yashika, I will. I don't know what else to do apart from plead and beg now. I have pierced my ears, grown my hair, started laser for facial hair, am eating everything I can find which is high in estrogen. Even did the RLE like he wanted. He was insisiting I tell my workplace that I am trans, but I refused - they would fire me, and I would have no job. Worse, the news would spread and unemployability would be a big concern. Anyway it will be. But apart from this, PLEASE suggest anything I should differently to convince him? :\
I am going to NIMHANS currently.

AnuLuna How is it going for you now, AnuLuna? What stage of your transition are you in? Also, I think that the idiots who suggested exercise should just be disbarred from counseling for conditions they do notno experience with, and more importantly, clearly make no effort to understand either.

sameera38 Thanks, Sameera. I know about the RLE for GRS, but Its not there for HRT which is what I was looking for, as Honey also mentioned. Its just not there at all. I did mention I want full GRS in my initial meeting, but I am first keen to start HRT and then only, take a full decision. I just dont understand why the doctor won't let me start, even after six months of evaluation. ?

How has been your experience with doctors/ transition so far?

AnuLuna

I am quite lucky than all of you in some terms... I got GD certificates from the doctors from the first time I met them or Maximum is 3 Months. I am firm about what I want to do and want to be in life. But few doctors who doesn't know about what I am going through tried to counsel me to Exercise regularly, and bullshit.

August;2013. I went for a psychiatric evaluation, After evaluating me that I have Gender Dsyphoria after two to three sessions they called my aunt and spoke with her when my parents are not available for that session. She is not happy with the doctors answers. Don't know what happened but after some time what I observed is doctors suggested not to go for any surgery and any treatment because of my family background. I didn't expect doctors could get influenced by parents.

But at the end they said only one thing, " You can only achieve what you want, when you are Independent."
All the best to your life gal....

Honey

There is no such thing called RLE in the latest protocol.

Honey

HRT doesn't require RLE

AnuLuna

lana I started HRT in Sep,2013. Took low dosage for some reasons & No parental support. I am currently going through Laser Hair Removal and am working in a E-Commerce company.

sameera38

lana
Can you ask this to your therapist directly this question?
Put few more options in front of him, like:
1. Is he worried about the legal context of diagnosing Dysphoria?
2. Can you give a written document of 'Declaration of a Transgender person'; by making an affidavit ?

The dialogue needs to be straightforward!

yashika_1989

lana Am really sorry you are going through this. See below an abstract Wiki regarding the RLE

"As of the seventh version of the SOC, a three-month minimum requirement of RLE is no longer part of WPATH's recommended criteria for HRT. A referral letter alone from a qualified mental health professional now suffices. The SOC state:[2]

Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's responsibility."

The requirement for a RLE is of a surgeon before GRS and of Endocrinologist (in some cases) and not of a psychologist or a psychiatrist. Try reminding this person that as a psychiatrist his job is to evaluate your state and that you align to "female brain" and that you have no other mental condition that interferes with the gender dysphoria. He does not have the responsibility of seeing how well you do RLE or how you look when dressed in female clothes.

Did you try to escalate this to his superior. In your place I would have done that. Hope things get well.

lana

AnuLuna That's great ? 3 years on HRT must have some nice results? Are you going to work as a woman? Sorry for the questions, but I am so keen to understand the journey to come ?

sameera38 Thanks, Sameera. Will do. I cannot wait anymore. am trying to be as straightforward but the junior doctors are not very experienced, I think.

Honey

After five years of evaluation ....I get nothing fruitful

AnuLuna

Honey Oh!! What wrong with them?

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