Counseling

I still haven't started taking Testosterone (T) yet.  I was supposed to start a week from yesterday, but I was assigned a new intern for my counseling, which pushed back my schedule a bit.  I don't actually know when I'm going to start at this point, but I'm hoping within a month.  It's very frustrating not having a timeline anymore.

Since most of you probably don't know what the process is for starting T, I'm going to take this opportunity to go over it.

The first step is figuring out that you're transgendered and that you want to transition.  Not everyone does decide to transition.  For some people deciding that you want to transition can be the biggest step of all.  For others, it's something they've known their whole lives.

From here there are two steps a guy can take.

One step, is to speak directly with a physician who will prescribe Testosterone.  This is not the most common avenue for obtaining a prescription for T.  For one, it's very difficult to find a doctor who knows much about how T will affect their FTM patient.  If for some reason a doctor doesn't know much about it, but is open minded and willing to learn, often the patient will have to teach the doctor.  Transpeople who want to transition, have often done extensive research into the effects of the hormones they need to take.  In many areas they are well equipped to teach others, however, most are still not trained medical professionals.  So, essentially, the patient ends up dishing out quite a bit of money to teach their physician how to treat them.  Most physicians are not comfortable with this arrangement (understandably), but if there are no other options and they feel strongly about helping their patient some doctors will do what they can and learn along the way.  This approach completely legal, if not recommended.  Of course, someone has to be the first in their area.

The second option after figuring out that you want to transition, is finding a trans-friendly therapist/counselor who will write your "letter".  You then take this letter to a physician who prescribes you T and monitors your physical health.  The physician quite possibly is not any better informed or trained than any doctor, but because their patient went through a therapist first it's possible they might have access to additional information.

This process basically follows the Harry Benjamin Standards of Care (SOC).  "Standards of care for gender identity disorders are non-binding protocols outlining the usual treatment for individuals who wish to undergo hormonal or surgical transition to the other sex. Clinicians' decisions regarding patients' treatment are often influenced by this standard of care (SOC)." (see this wikipedia article for more info and reference)

Your letter is basically a letter, signed by a licensed mental health professional, stating that you desire to transition from one sex to the other, and that your reasons for doing so are legitimate (in other words, you're not schizophrenic).  It used to be that mental health professionals would write a letter officially diagnosing you with Gender Identity Disorder (GID), for which the treatment is to transition.  This practice has been slowly changing.  Being diagnosed with a mental illness can be extremely hurtful, especially when no illness is actually present.  Many mental health professionals these days consider it enough, simply to say that their patient is of sound enough mind to make this sort of major decision.  This is the practice at Seattle Counseling Service (a GLBT focused counseling center), where I'm going to obtain my letter.

It's preferable to find a counselor who has done counseling for people who want to transition before for much the same reasons as finding a doctor who has helped other clients transition before.  But again someone has to be the first, and if the counselor is open-minded it's important to weigh having experience in trans issues against a counselor/client relationship that may already be well forged.

There is actually a third option for obtaining T, which is to obtain it illegally, without a prescription.  This method is not recommended for all the usual reasons taking controlled substances without a prescription isn't recommended.

According the SOC (also used internationally) 3 months of counseling are recommended before issuing a letter.  My three month mark would have been this Monday (5/11), but the intern I was seeing ended her internship and left Seattle Counseling.  I saw my new intern only last week.  Understandably, she felt the need to get to know me a bit better before writing my letter, so I'll just have to wait and see if she can give a me timeline the next time we meet.