18) Did you have to go through some type of psychological therapy before the change and after the change? If so, what did the therapist say or do?
Sexual Reassignment in the United States and many other countries is governed by the Harry Benjamin STANDARDS OF CARE FOR GENDER IDENTITY DISORDERS which were first written in 1979 and have been revised 5 times since.. The 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). Early in the history of sex reassignment surgery there were some unpleasant experiences by some who had the surgery and regretted it later. And, additionally, by the time that I sought the surgery, I had also met the requirement that a candidate must have lived and worked full-time in their new identity.
Personally, I had a difficult time finding a psychologist or psychiatrist in this area that was qualified to work with transgender/transsexual issues. Gender identity disorders are not exactly a common challenge that most people face. Whenever I would find someone who would attempt to assist me, their initial primary focus was always on how much I was drinking at the time…. They failed to understand that the reason I was drinking so much was that I wanted to escape the unpleasant reality I was living in at the time. As a result, I had no formal psychiatric evaluations before my surgery. The doctor who did my surgery clearly stated in his letter that “ We must have TWO PSYCHIATRIC EVALUATIONS WHICH SPECIFICALLY RECOMMENDS SRS OR SPECIFICALLY STATE THAT YOU ARE A GOOD CANDIDATE FOR SRS OR ANY SEX CHANGE PROCEDURE SUCH AS AUGMENTATION MAMMAPLASTY. These are to be done by Psychiatrist or Psychologists who are recognized, licensed workers in the gender or sex-oriented field. A letter is required from your Endocrinologist outlining the history of your hormone therapy.” Instead, when it came time for me to present these letters to him, he offered me the opportunity to obtain letters from my medical doctors that would contain the specific required wording, and I believe I was able to eventually provide him with letters from 5 local physicians.
Remember that by the time I was ready to progress toward the sexual reassignment surgery, I had already been living as a female full-time for around 2 ½ years. I was reasonably well adjusted to my new lifestyle, and certainly had no regrets. That fact also met another condition of the Benjamin Standards of Care, which basically require someone to live the role for at least 2 years before the SRS. Most surgeons in the United States and Canada who do perform the surgery do adhere to those guidelines, though you can go overseas, say to Thailand, and have the surgery performed once you have lived the role for only a year. While it is much cheaper to go to Thailand for the surgery, I myself just wasn’t ready for that. I even had a former friend, a truly amazing person in many ways, who offered me enough of his frequent flyer miles to cover my air fare over and back. But though I was aware that medical care in Thailand was quite good, I decided to have the surgery done in the USA primarily because of my history of medical challenges. These issues, primarily heart and lung problems, also required me to obtain a medical clearance before the surgery. And even tough I obtained it here, the surgeon also had his own physician examine me once I got to Neenah, and before the surgery. As a sidebar, would you imagine that the biggest obstacle SRS candidates can face is obesity, as it seems that the surgery simply does not heal well in obese individuals.
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