Whereas we, the
transgender people of the world, are tired of being exploited by
the power imbalance of self-declared "professionals" whose control
over our lives abuses us with the herein listed offenses,
Whereas we are tired of being quoted
one price for services, then nickeled and dimed with expenses that
were obvious but overlooked in estimates, yet for which we must
pay,
Whereas unclear treatment goals and
timelines leave us uncertain as to costs and timelines we will
encounter,
Whereas we are tired of those
uncertainties leaving us feeling like automatic teller machines
solely for the benefit of health providers,
Whereas it is our lives and
our progress that are delayed when "professionals" drag
out treatment and/or subject us to unnecessarily long turn-around
times in providing approval letters for which we are paying,
Whereas the artificial roadblocks
("gatekeeping") have led less patient members of our community down
dangerous alleys in pursuit of their personal wholeness,
Whereas rigid gatekeeping by some
enables and incentivizes unscrupulous providers to ignore
guardrails for monetary gain,
Whereas "professionals" have
pathologized us in their journals and writings based on our
variance from society's status-quo, and not based on our own
happiness or function,
Whereas we find it disrespectful and
untruthful when "professionals" allege benevolence and helpfulness,
yet refuse to use our pronouns, chosen names, and gender
designations,
Whereas it is costly, ridiculous,
and insulting for those of us who have lived in our desired roles
for years to be obligated to get second opinions,
Whereas it is a costly waste of time
to be evaluated by "professionals" who assert they are qualified
yet are not familiar with such basics as standards of care,
approval letters, or lived experience durations imposed on us by
those standards,
Now, therefore, we demand better
treatment, and set forth these standards of providership.
Our Demands
Our goals in this endeavor are to ensure better treatment by
providers. In particular:
Transparent pricing.
No more hidden costs demanded of us after-the-fact. We want to
be billed fairly.
Transparency of competence and experience.
Too often we meet therapists who claim expertise with gender, but
who are woefully uninformed or underinformed, working with outdated
concepts and models, and/or are oblivious to current medical
standards and practices. We do not want to waste our time and
money on "experts" who aren't expert.
Transparency of approval process
Mental health providers vary in their willingness to write
approvals: some are liberal, requiring we meet minimum standards;
others conservative, with expectations beyond the established
standards. We want to know what is expected of us, and for how
long, to receive our approval letters. Too many of us have
encountered providers who never had intentions of approving us for
the next stage of treatment, deliberately delaying our lives rather
than being honest their intention was to "cure" us.
Transparency and clarity of approval requirements.
Approval requirements vary by provider; the Standards of Care (http://wpath.org/publications/soc) cannot
be relied on as authoritative. Thus, all providers must be clear
what approval letters are needed, required contents, and mandated
credentials of their authors. Provider demands must be clear
up-front, so we select appropriately credentialed health care
providers and therapists, and so those therapists only need write
letters once, saving them time and us trouble and money.
Better and more tolerant scheduling.
In the face of long wait times, we require the ability to schedule
care once approval letters are underway, even if some are
outstanding and/or have minor deficiencies in their content. We
should not be subject to weeks-long delays because of a typo, an
omitted date, or a minor detail left out. We should be able to
schedule with one letter, with the understanding that other
approval letters (or changes to existing ones) are due a reasonable
time before the scheduled date.
Improved Standards: Value for our lived experience
Those who live in their identified gender long-term and who have a
similarly long-term relationship with a therapist, should be exempt
from second letter requirements. Or, expressed a different way,
long-term lived experience should be considered an equally valid
second credential toward affirmation surgeries. For those of us
privileged enough with wealth or income to afford navigating the
system quickly, a second opinion is perhaps acceptable before
proceeding with irreversible surgery. For those on the slow path,
this is ridiculous: how will one or two sessions with an "expert"
outweigh years spent with a regular therapist? And how could that
possibly outweigh years of lived experience in informing us of the
best decision? It cannot.
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