Hopefully this post will go a little better than my last one. :) As I said there, that topic and this one might elicit some disagreement among the transgender community and to me that's fine; healthy discussion is something that I feel is a good thing. That all being said, on to the topic at hand.
One of the "nasty terms" that commonly comes up in conjunction with transitioning is "Gatekeeping". While, the WPATH guidelines have been relaxed over the years, at least in my opinion, many people pursuing transition still find them onerous. Now, when I first started considering transition - and granted it was a short consideration - I took a good look into what it would take. I knew I wanted to start HRT sooner rather than later due to my age and that left me three paths I could pursue.
The first path was self-medication. To me that was a non-starter. I was on too many other medicines already, and really didn't want to take the kinds of chances that go with that. I love my wife and daughter and I wasn't about to risk my health in order to cut a few corners. The second path was "informed consent", and the third was to follow the traditional WPATH guidelines. I gave strong consideration to each of these two paths as they both had their allures. *IF* I could find an informed consent clinic I could get started on HRT sooner and without having to seek therapy which was something I wasn't keen on. However, as I dug further it appeared that all of the reputable GRS/SRS surgeons would require authorization letters, which if I went the "informed consent" route I wouldn't have. Now technically there was nothing that would stop me from starting with "informed consent" and then pursuing the letters for surgery; but I felt that if I was going to need those letters eventually, that I might as well "do it right" so to speak. Now that's simply a figure of speech and by no means meant to imply that "informed consent" is wrong. Now following the WPATH guidelines meant that I would have to seek out therapy and get authorization to start HRT which did delay things a bit and did frustrate me; but in the long run I've been happy with my choice, and I hope I've made that clear in the various blog entries I've made.
However, this isn't really about me, but about those that consider the WPATH guidelines onerous, or as many put it "Gatekeeping". Now let me say I'm sure there are therapists, and other medical professionals who could legitimately be considered "Gate Keepers" in a negative sense of the word, but I strongly doubt that it's nearly as many as it's made out to be. Under the best of circumstances, transitioning is hard; and how many of us are operating under the best of circumstances? Is it really wrong to be expected to undergo at least some therapy prior to pursuing the social, physical, and emotional changes that come with transitioning? Especially those that are younger and/or don't have much (if any) support system in place?
I know not everybody can follow the WPATH guidelines. There are costs associated with therapy, doctor's visits, lab work, and so on. Not to mention other considerations which may make the WPATH guidelines difficult at best or even simply not doable and for those that are simply unable to follow them I understand completely and can understand the "informed consent" route. I still don't think I could advocate self-medication even in those circumstances, but if you feel that's right for you then you need to do what you need to do. There are also those that simply believe they don't need therapy, etc. Perhaps they are right; I think I personally could have done without it myself. However, I am grateful that I undertook it (and continue to do so) as it's been very beneficial for me. I think it comes down to a maturity issues; are you really mature enough to handle transition without therapy for example? I'm sure a great many people would say "Yes" without a second thought and again perhaps they are right. But if you're so sure and there are no other barriers (financial or otherwise) preventing you from therapy, would it be so bad to at least try it? The same can be said for HRT, if possible isn't it better to do it under a Doctor's care?
Just because the WPATH guidelines are there doesn't make them a bad thing. I've seen quite a few people who have transitioned, up to and including post GRS/SRS that are not any happier now and in some cases more unhappy than they were before. I'm sure some of them did follow WPATH, but what about the ones that didn't? Would following those guidelines have made a difference? I cannot say one way or the other; but I know I'd hate to have transitioned outside of the guidelines and ended up unhappy. I would've always wondered if things might have been different if I had adhered to them.
Even the HRT guidelines have been relaxed, in prior versions of WPATH a full year of "Real Life Experience" (RLE) was expected pre-HRT. Many point to things like this as an example of gatekeeping and I'd even respectfully disagree with that. HRT does cause changes and as some of them are permanent, shouldn't you realize just what you are getting into first? My RLE started several months pre-HRT and I was fine with that. Now that was a choice I made; but to me the bottom line was that I saw no reason to wait. HRT is not some "magic bullet" that will magically turn you into a "woman" over night. Yes it will make changes, but they do take time and truthfully there's a lot more to being able to live full-time than just how you look. Voice, mannerisms, and confidence (the single biggest thing in my opinion) among other things will greatly impact how you are perceived and none of those are really dependent upon HRT.
It's late and my mind is starting to drift so I guess I'll cut this off here. Once again let me say I'm not saying anyone in particular must follow the WPATH guidelines. We must each do what is best for ourselves when it comes to transitioning. However, I do feel the WPATH guidelines do have a lot of merit and have an undeserved poor reputation. Just because you don't necessarily "like" something doesn't make it wrong and I see a lot of people who seem to think otherwise.
Okay, I'm off my soapbox now.
- M
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