So about transition… WPATH, Informed Consent, and me.

Following yesterday’s post…

hope-in-a-bottle-fiMy first thought was to follow the WPATH solution of finding a therapist first. Please understand I’m not an expert, and I’m a bit of an anarchist, and my hatred of gatekeepers telling me what I feel and whether it’s valid colors every word I’m about to write.  As a contrast, informed consent is about personal agency. An informed consent healthcare provider believes the patient has the right to determine their own course of treatment and understands their own needs. That provider extends trust to the patient to self-report their situation and be responsible for their outcomes. No gatekeeping beyond that of the doctor writing the scrip or not.

WPATH bases every step of transition on a letter from a therapist stating that you’re not too crazy to decide your gender identity for yourself. It requires you to demonstrate that your gender crisis is severe enough that the “extreme” step of hormones can be recommended as a desperate attempt to mollify your delusional ass. If you’re still sticking with it after a period of time, that person will write you a letter recommending you receive surgery as well, because you’re just that troubled and it’s really all they can do to make you comfortable… You know, the way they give morphine to the dying to ease their hopeless final hours.

“This one can’t be cured. Let’s just give them the treatment.”

The issue here is that science suggests this is not a psychological disorder but a neurological anomaly. Several studies of trans* people’s brains have shown marked differences from those of cis people, suggesting that transsexual urges–the desire to not only socially transition but fundamentally alter the body in painful and permanent ways–stem from very real genetic issues, determined before birth. Preliminary studies indicate that trans* men were possibly exposed to certain chemicals in the womb which caused them to develop “male” brains without developing the attendant “male” bodies. I’m not a doctor or a scientist, but I avidly devour research on these matters. It’s personal in a way few other things are. I want answers desperately.

Most doctors are not desperate for answers to the trans* question. They’re woefully undereducated on these issues. They may continue to hew to the outdated belief that this is all some kind of mental illness when the DSM-V has changed its designation from “gender identity disorder” which implies any alternate gender identity is a disorder to “gender dysphoria.” Plenty of gender non-conforming people don’t experience that. Social dysphoria, sure, but not gender dysphoria. They aren’t  pathological unless the intersectional feminist drive to overthrow the patriarchy and create space for healthy and unique self-expression is pathological.

It’s the gender dysphoria which is now indicated for treatment as opposed to the premise that the identity is the problem.

So instead of taking the WPATH therapist-first route… I decided to go the informed consent route. I already know who I am. I’ve been seeing shrinks off and on for years. I have a psychiatrist I see regularly for other reasons. I have a gender-atypical BFF who is not afraid to ask me the hard questions and learn with me.

Cause, sure, it’s a problem in the brain, but most healthcare professionals–and most people–still look at it as a psychological issue rather than a neurological one. They still act as if transition is a behavioral therapy to soothe the savage trans* beast rather than the only medical option for those whose flesh is easier re-crafted than their fucking brain. Gender dysphoria is what one experiences when one’s brain expects a certain conveyance and instead of the correct body piloting it around gets one it’s not entirely sure how to operate. It’s an inherited genetic condition in the brain itself.

Are there emotional and psychological effects stemming from that? Obviously. Is a therapist useful for treating those symptoms? Sure, but I’m not feeling too muddled on those points. I’ve got this.

So fuck the WPATH, at least for now. I did track down a promising candidate for the WPATH route, a therapist in Shenandoah who was willing to handle it by Breakthrough webcam therapy sessions and took my insurance, but ultimately she was Christian, and I’m not ready to trust myself with religious people. I have great respect for people of faith, but I am too fragile to put my fate in those hands right now. Maybe someday I’ll revisit where my trans* identity fits in with Christian faith, but today is not that day. After spending my childhood and teens up to my neck in my former faith, it’s triggering.

Even calling Legacy, which is located in the most queer-intensive section of Houston and specializes in trans* health issues, I encountered some hurdles. The world is just not set up to make it comfortable for trans* people to get help. This is where I should note that making phone calls is my least favorite thing. I, quite frankly, far prefer having blood drawn. I prefer dental work. But I called.

I had to give them my “real” name of course. The legal one I can’t just go change to Will because reasons. I had to say my sex (as opposed to gender). The gritted out “currently female, technically” didn’t faze the receptionist, but it irritated me that they didn’t have a less triggering process. And here’s the big thing… I had no idea what I needed when I called. I didn’t know who did what or how, despite having read a million things on the internet. When it came down to it, when a stranger was asking me casually (all in a day’s work!) “so how can we help you?”

Well, I babbled a little. I felt like an idiot. I put on my best Southern Fried Gentleman persona and charmed her with my self-deprecating graciousness, even as my heart sank into my guts and ratcheted up into my throat by turns. Apparently what she wanted me to say was something like, “I’m a transgender new patient seeking hormonal therapy to transition from female to male. With whom do I need an appointment to begin that process?” So for those of you who haven’t yet made that call, there’s your script.

The first available appointment is June 26th, months away, because that’s how booked these people are. That’s how difficult it can be. You screw up all your courage, you brace yourself, you’re so beyond ready for something to happen, and you get to hurry up and wait. A little anti-climactic? Sure. Exciting? Oh god yes. You ready, Clancy? Maybe we can get Korean after.

Maybe I’ll just hear that as a person with a bipolar diagnosis on file, I still have to go to a therapist and follow WPATH. Maybe the informed consent will require a side of trans* support group, requiring me to drive 45 miles one way a few times a month. Maybe Dr. Vanek will inform me my health is still not good enough to go on T yet, and I’ll get a new goal post to work toward over the next year. But I’m on my way, and it’s been a long time coming.


  1. I have some questions can you please email me

  2. Pingback: A philosophical transition update. - Thursday Euclid

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.