A lot of trans people are denied approval for top or bottom surgeries due to a doctor feeling like they aren't ready emotionally for the transition.

There have been efforts to make transitioning by surgery covered under insurance policies, but that's slow going and only a few states include it.

After all of the documentaries I have seen where post-op trans persons are still unhappy and regret getting the surgery (there's almost always a complication that makes them feel like it wasn't worth it), I think doctors are not inclined to approve the surgery just because someone thinks they want it. It's a very long, painful process.

You have to be in therapy for a certain period of time -- basically you have to jump through hoops and the rejection a trans person may feel because of these hoops only serves to keep them in therapy and out of the operating room.

I know it isn't exactly the same thing, but I've always compared it to the girl with really, really low self-esteem who gets her breasts or her nose done and thinks she's going to wake up feeling perfect and realizes that once the bruising and incisions have healed, it's still her. She's still the same girl in her mind she was before the surgery and it doesn't do anything to fix her emotional issues with herself.

Exactly. With such a huge, life altering surgery, I think doctors have to protect themselves from lawsuits.

Personally, I think people should do whatever they want with their bodies, but when you need to employ someone else to change it for you, then you're involving another person. From an ethical standpoint, doctors need to know that they are doing the right thing, and I think that's why there are so many hoops to jump through.

Wait, wait, wait...In reference to your "girl getting a nose/boob job" analogy, are you saying that gender reassignment surgeries are not generally beneficial to trans* people, and that being trans* is an "emotional issue"?

But, see, this kind of mentality assumes that gender reassignment surgery is something that a trans* person enters into lightly, which I can guarantee you is not the case. I know several people who have gotten some form of gender reassignment surgery (both on the MtF and FtM side) and in every occasion, it was something that the person had wanted for years before they actually started seeking it out. One of those people even had their surgery botched in a pretty dramatic way and, while they regret their choice of doctor, they have never regretted wanting or getting the surgery.

Do doctors need to protect themselves from liability issues? Absolutely. But all too often, the "waiting times" imposed are completely arbitrary and subject to the personal prejudices of the doctor. And this is wrong. A patient has every right to have input into their medical care. In the case of a trans* person, this is not something that can be seen on an MRI, or measured with blood tests - the doctor has to (and should!) trust their patient.

Are there people who would enter into hormones/gender reassignment surgery rashly? I'm sure there are, even if I have never met one (and I am heavily involved in the trans* community). But that is what we have waivers and consent forms for. As long as a doctor does their due diligence by properly and thoroughly informing their patient of any risks associated with the medical procedures they are about to undergo, then they have ethically and legally fulfilled their obligations as a doctor.

You just said everything I couldn't articulate. Perfect.

ok, but being turned away from something that you need to be able to function is also "major" and potentially life-ruining, and that *is* something that is done quite lightly by medical professionals in many places.

i'd be very careful to throw around vague statements like "the hoops are there for good reason" if i were you. and in many cases the "precautions" are detrimental to a person's well-being and health, especially when people can still be turned away for not conforming well enough to the standards set by the gatekeepers, including but not limited to how well they conform to their expected gender roles.

i mean, you are forced to put your life in the hands of another person, and where i live, you don't even have a right to a second opinion. how are those "hoops" there "for good reason"?

I agree with your comparison Stormy, although I understand that the situation is often far more complex than that for a trans* person. Honestly, it's a hard question to answer and I don't know that I can really say one way or another that it "should definitely be this way" or "it should definitely be that way." On one hand, this is a life-altering surgery that, as others have said, no one should enter in to lightly. On the other hand, doesn't everyone have a right to choose what they want to do to their body (even if that transformation may potentially be a mistake)? I have a tendency, when I think of people I don't know, to fall towards the latter side of the spectrum. It's your body, so if you want to have a life-altering surgery or physically irreversible surgery, it's your choice. Who am I to tell you not to?

However, when I think of people I know and love, it gets a little more complicated. I've known a number of trans* individuals who have struggled with their identity for many years and sometimes realize that perhaps they are something else entirely after living as a male/female for an extended length of time. I can only imagine how confusing (and awful) it would be for someone who was, say, born biologically male but felt female all their lives to participate in gender-reassignment surgery and find out a year or so later that they made a mistake. What happens to this person then? In an extreme scenario, what happens if no one ever asks; "Are you sure you want to do this?" or if no one ever really challenges them to find out why they want to do it. I think it is possible that there are legitimate and not-so-legitimate reasons for wanting to have the surgery because it is not a black and white thing. Beyond this, the body is a confusing thing of and in itself and people change constantly... I would never wish a fate like that one someone I knew if I knew I could prevent it. ( This isn't to say that there aren't trans* individuals who are completely prepared for the surgery, just that the stakes for sending an individual who isn't prepared are pretty high. )

The process is there because unfortunately there have been a few people that weren't ready and jumped into it, and then realized they weren't transgendered. then they were pretty fucked, cause there really isn't a reverse-sex-change operation.
It sucks that you need "approval", like you have to prove something to someone else. but I think seeing a therapist is helpful because having someone to talk to about any issues you're going through really does make you feel better.
also, Christine McGuin, a transwoman and transgender surgeon, says EVERYONE hits a heavy depression period after surgery. whether it be immediately, or a few months afterwards, you need to have a relationship with a therapist because they can help you through that depression.
obviously it should be someone you feel comfortable with and won't just jam a bunch of drugs down your throat.

I wish I had had a therapist after I had my cosmetic surgery. I had lipo for weight loss because my joints can't handle how heavy I am. I definitely hit a depression about a month afterwards. it was mostly due to being frustrated at being immobile for that long. I made it through, but it would have been a lot easier to have someone to talk to that was unbiased.

I think if there were more doctors and therapists trained and OPEN (cause there is still a ridiculous amount of transphobia and homophobia) to these issues, the process would be smoother and less aggravating.

Beautifully said.

No. The standards are there for a reason.

Just a secret I found out: some doctors are up in the clouds, riding on power and a textbook idea of who 'should' be which gender. That's not for a doctor to decide. At the end of the day, the only one feeling what you feel and the only person you will 100% definitely be stuck with the rest of your life is yourself.

If one doctor isn't cooperating, go to a different one! There are LOTS of doctors who will even do surgery WITHOUT a letter. It's not a legal requirement, it's just a bit of paperwork that people have fallen into the habit of.

Sure you may need to call 3, 6, even 10 doctors but YES they will do it without a letter. Already got two surgeries done (all the extra parts removed) and already have two other surgeries I am looking forward to, not gonna need a note for either of them.