Interesting article! I always thought there was piles and piles of therapy sessions required to "convince" your therapist you were serious about (mostly) permanent changes like surgery? Maybe if you're uber rich you get to buy off people and skip that, though.
<<A subset of the "transgendered" in the title, since we're just talking about people who transition...>>
Basically, if you know who to talk to or where to go, nowadays you can actually get hormones w/o prescription -- usually from overseas, and it's the same stuff you get from a doctor.
The gist is that GID wasn't widely known in the 70's, and there were few specialists; nowadays there's a lot more awareness in the medical community and the consensus from AMA is that medical treatment is a viable resolution since therapeutic success was arduous and rare. While that might be good for those who seriously need access to medical treatment, it also has eased up some of the gates that formerly made physical transition a real hardship for transsexuals.
Technically, Harry Benjamin's standards of care (SoC) were in effect until maybe the mid-2000's and were used to make sure people didn't slip through the system. I think those standards were subsumed into the WPATH standards, which are international in origin, a few years ago. The standards are just a proposed regimen that doctors should follow when treating people medically. Your reputation surgeons WILL follow the standards even though there is no punishment for them not to (as far as I know), at the bare minimum to protect themselves against a malpractice lawsuit by patients like Charles Kane; considering the nature of the surgery, you can only imagine what malpractice insurance costs are like for surgeons in that line of work. (I think one doctor said her private practice paid $60K a year just for malpractice insurance.)
I don't feel like googling it, but the basic rules usually include living at least a year (24/7), including holding a job, in the identified gender; and then two letters of confirmation, one of them at least from a licensed psychiatrist/specialist rather than just a therapist.
There's a wide degree of practice nowadays. At one end, you have doctors who are willing (in conjunction with therapist assessments) to prescribe puberty blockers for trans-identifying teenagers, so that their bodies don't change a lot before they become legal adults and can decide whether or not to pursue transition; at the other, you have places like Johns Hopkins, where often they will make patients live in the target gender for at least a year WITHOUT hormones... which is more "old school thought." The standard practice lies somewhere in the middle.
Do you think there should be an enforced waiting period between phases i.e. starting (hormones/whatever), dressing/whatever else for part-time or full-time, getting the official stuff changed, then a waiting time (months, at least) before actual surgery? I could see people heatedly arguing for either side. I would probably lean to the side of some kind of waiting period, but seeing as I don't really know much of the issue, I'm not exactly qualified to have an opinion. I think both situations are pretty tragic (forced to wait, or rushing into a life-changing decision). Maybe person-by-person basis is best, I don't know.
Personally? I think decisions like this are complex to begin with, and since they are at least based somewhat on emotional states, it makes a lot of sense to have waiting periods as well as various hoops, but with flexibility based on the patient (and money shouldn't have anything to do with it)... but I seem to be on the conservative end of things. most people -- especially patients who transition late in life -- seem to really resent having anyone tell them what to do. The head of one support site noted that for no other big life decision (having kids, getting married, retiring, etc.) are people required to go through a psychological battery of tests and be "given permission," so it seems ludicrous.
People also are not required to get permission to get "cosmetic surgery"; if you want a nose job, the doctor gives it to you if you have money. If you want liposuction, the doctor gives it to you. I feel personally like it's a double standard for prominent voices to decry this sort of surgery as merely "cosmetic surgery," and yet then enforce so many stipulations on it. If it's just cosmetic surgery, then people should be allowed to pay out of pocket whenever they want; if it's NOT (and I don't think it is), then hoops make more sense... and it should also be covered by medical insurance, as the AMA suggested and the IRS validated this past year by announcing it was now medically tax-deductable in the United States.
Still, since the causes of GID feelings are not understood and perhaps not identical from patient to patient, I feel personally like people should have to go through some period of therapy, and that for each stage there should be a period of time where they get to adjust to the new change. I mean, we all see what happens when people "fall in love and get married" after six weeks; at least then, they can get a divorce. At the time, they're very sure of themselves. I think caution is prudent. You don't want to make a horrible mistake.
...I find because I'm not transgendered that i love talking to transgender people, its so fascinating, something I'll never fully understand but can accept it.... But I heard that for a lot of people that same scenerio doesn't go as well.
heh. yeah. you got that right!