The Right One

posted September 29th, 2013, 8:56 pm


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September 29th, 2013, 8:56 pm

LittleLynn84

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This one may require a bit of explanation if you’re not transgender.

If you’re not familiar with the term, “gatekeeper”, it’s a very feared and hated concept in the trans community. The unfortunate thing about being trans, is that you kinda have to be “approved” in order to begin transition. Particularly, you need a therapist/counselor/psychiatrist/etc to diagnose you as such before moving forward. If for some reason, said professional isn’t convinced you’re trans (or has some kind of personal stance against such things), they essentially have the power to halt your transition by either outright refusing to help or sneakily dragging things out. Without their diagnosis, you’re probably stuck. Most doctors won’t prescribe hormone therapy without the mental health professional’s letter of recommendation (I’ve heard rare instances where some will, but I wouldn’t depend on that).

So what Jessica is saying in the first panel about lying or exaggerating is something that unfortunately happens. Some trans folk simply don’t want to have the SRS (sexual reassignment surgery). Some suffer much milder cases of dysphoria. Some trans girls are tomboys, and some trans boys are femme. Nothing is wrong with any of these scenarios. But there are therapists out there who are, sadly, only impressed by the extreme cases. It SHOULDN’T have to be like that, and thankfully, for me it wasn’t (although, I AM kind of an extreme case). But I have a lot of friends going through this right now getting jerked around by professionals content to sit on their thumbs. It’s unfathomable to me.

Hence, why I think if your therapist fails to yield the results you want, look for another one. There are those that are NOT gatekeepers who will help. I know this. I’ve seen it firsthand. You shouldn’t have to lie or wait for someone to hum and haw. They’re there to help you; if they’re not helping you, don’t waste your time and money with them. Move on. Keep trying. You WILL find someone who can help as long as you don’t give up.

Wow. Kinda went on with this one. I hope I was able to inform with this though, whether you’re trans or not. ^_^


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June 24th, 2017, 5:33 pm

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September 29th, 2013, 9:30 pm

renchikolul

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yea Ive been through a lot of therapists and doctors but they just don't know how to help me with transitioning. A lot of my friends who are trans cant find a 'gatekeeper' to allow them to transition and the one who I do know who got approved said he was an extreme case ( the therapist only agreed after he met the stereotypical version of a transman).Still praying to transition or at least find a therapist by the end of this year.

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September 29th, 2013, 9:44 pm

Hannah (Guest)

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I guess I was more fortunate than I realized with having a family doctor who was open to starting me on HRT as long as I did it slowly (few weeks of T blockers, then a few weeks of estrogen, then increase doses of both etc etc). I've honestly never heard the term "gatekeeper" used in that context, but unfortunately I'm not so lucky that I didn't get why it was used the second I read it here.

Fortunately, for those of you who aren't aware, I believe that legally in most places (at least in North America as far as I know) you -can- request a sort of "interview" with perspective therapists where you can meet them, ask a few questions to determine if they're right for you, and you don't have to pay for it. Of course any subsequent sessions will require payment (if they aren't covered by your insurance/work place), but a free partial session where you can ask what you feel are the most important questions for determining whether or not they're right for you is still pretty good and might save you some money as well as keep your morale up a little (you can escape paying for some bullshit, which is always a good thing). If anybody is in the midst of looking for a therapist, I would seriously suggest inquiring about this as an option since I know several people who did it until they found the right one for what they needed (not all of them for trans* issues). I can't guarantee it will be an option absolutely everywhere, but it's definitely worth looking into and asking about.

Also, for those of you who are looking to start hormone therapy, but are in the midst of finding someone who will cooperate with the full treatment, I would recommend asking about hormone blockers at the very least at a walk in clinic. A lot of the time the doctors there are too busy to ask follow up questions so they'll just write up the prescription for you and if you have too you can usually just say you missed a regularly scheduled doctor's appointment to get your prescription in loo of any long explanation. By the way girls, guys, people somewhere in between, blockers are also given to cis people to help with various medical conditions, so you could also do a little research and ask about them for that reason if they're being stubborn or you're nervous about being honest. There are always loopholes so just don't give up.

The truth is (as I know far too many people are familiar with), there are some people in the medical community who are just assholes, but hormone blockers at the very least don't require permission from a therapist in most places, just a prescription from a doctor, so even if you have to wait a bit to begin the full treatment, you can still usually get on blockers at the very least.

Anyway, the best of luck to anybody reading this who might be starting, or in the midst of their journey, it's a long road but it's sure as hell worth it and there will always be people who have your back somewhere. :] <3

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September 29th, 2013, 11:52 pm

laurenlovesgirls

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if I ever get me a therapist I bet they would have a hard time with me since I like wearing "boy" clothes and identify as butch so I am not the stereotypical kind of girl

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September 30th, 2013, 9:06 am

LilyFlareVII

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Not trying to defend biggots or anything, but I could see how some therapist would want to make absolutely sure that you're 100% transgender before giving the ok to transition. I mean, you're making a life altering change to your body, and I'm sure they wouldn't want you to go through all that work and then one day have you come to them and say, "You know what, I changed my mind. Turns out I liked how I was, so why did you let me do this to myself?" So I could see it being pretty stressful deciding whether or not to give the ok.

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September 30th, 2013, 10:09 am

LittleLynn84

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@LilyFlareVII:

I understand taking precautions, but after a while, it's less about them being careful and more about them being careless. A therapist is supposed to observe for three months before making that decision, and hold off only if they remain unsure. The average person who would second-guess going through transition, would likely start having their doubts before reaching that point. With this in mind, there's a lot to be said that someone like Rain - who is a textbook example of a trans woman, really - could be doubted. If the patient is telling you, session after session, that they know how they feel, I would sooner guess that the practitioner is no longer playing it safe, so much as not paying attention to their patient!

I'm not saying that there shouldn't be any observation and analysis. I do see the need for it, and would gladly keep it as an integral part of transition. After all, some aspects ARE irreversible and there ARE risks. It would be horrible if someone trapped themselves like that not knowing what they're getting themselves into. But I think it needs to be handled better.

Before I started, I'd done a lot of research which scared me away from starting transition for a very long time. One horror story after another about gatekeepers dragging things out or outright preventing anything from happening. It was terrifying to me. I was worried I wouldn't be "trans enough"! That shouldn't be. My experience, when I finally did go, was not like that. He's a fantastic guy who never ever doubted a word I said. He managed to answer all of my questions and more. It still took him a while to write my letter (possibly to be cautious), but he assured me like five minutes into the first session that he WOULD do it (after I told him I was there with the hopes of starting transition). He was very open and very accepting. And I couldn't have asked for someone better.

And yet, I have friends who started therapy before me years ago, STILL trying to start their transitions. Many of these people have been my friends for years; and knowing hundreds of trans people by now, I KNOW for a fact they ARE trans (nobody keeps trying for years despite failure after failure if they're not serious about it). It's mindblowing that people have to go through this, and it's completely unfair. I understand the need to protect some folks from jumping into something they might not be ready for. But there are people out there who know exactly what they're doing and exactly what they want. They know the effects and they know risks, and they are willing to move forward regardless. These people should not be denied proper treatment. These people should not be struggling to start transition for years when they are very obviously trans gender.

I understand your position, and I'm not mad or anything (I hope I didn't seem like I was). I'm just saying that there's this fine line between playing it safe, and playing stupid. And there are very seriously practitioners that fall into either category.

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September 30th, 2013, 10:39 am

Psycho Yuffie

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I almost experienced this. Almost. The first therapist I want to was a university therapist at the counseling center on campus. It was a desperate time. I was depressed and suicidal. He helped me come out to my parents, but refused to help me down the transition road until he was sure I was transgender. Unfortunately, to him this meant wearing women's clothes before I was ready. Honestly, I'm a bit of a tomboy, so I don't really mind guy clothes--even now. I don't wear makeup or anything. That being said, my attitude is completely femme. It was quite obvious I was trans. My family had, apparently, known for years but they were waiting for me to come out. Eventually, he realized that he wasn't the right person to do this, so he contacted the head of LGBT resource center on campus and she got me into contact with a therapist who specializes in transgender care. From there, I transitioned without a hitch. So my first therapist was gatekeeping a bit, but he actually had the foresight to realize that he didn't know what he was doing.

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September 30th, 2013, 2:06 pm

Janna (Guest)

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I hope I'm not intruding with this comment (I'm a ciswoman and straight).

The most unfortunate aspect of mental care in general is that people have to therapist-shop, essentially. I have depression and anxiety, which makes searching for care a job in itself. My issues can be managed with support and medication, but it's taken a very long time for me to get to that point (at least two to three years). There are people with more severe issues than me that require a good therapist and they can't find one.

I think part of the problem is finding someone who understands the issue and whose personality doesn't clash with your own, or clicks with yours. There seems to be an unfortunate amount of doctors and therapists who just don't get it (which is more forgivable), or who refuse to acknowledge that your issues are issues (which is unforgivable in any case). The worst ones are those that refuse to even give you recommendations of other providers who could help you (and they are out there). Thankfully, most professionals aren't at that level of extremism and will recommend out.

Of course, then, there's the issue of insurance coverage (which is my pet peeve) and whether or not the insurance provider will allow it (they ought not even to have that privilege). This effects even those with common problems (I had a psychiatrist have to threaten my then-insurance company with having to cover anything that went wrong with me, because they wanted me on a different medication that they paid less for), so I can understand how something as specialized as transitioning can result in a gigantic charley foxtrot (I dunno your opinion on swearing, so not saying the actual phrase).

My advice is: Dig your heels in and don't let someone else dictate your existence to you. You can always go elsewhere and don't be afraid to let your providers know this. Don't get discouraged if things don't work out with one provider or more. You need a good fit to move forward. Finally, a good hug from someone who cares is always helpful.

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September 30th, 2013, 5:39 pm

Allie (Guest)

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@LittleLynn84: it should be noted that people who don't fit the WPATH narrative (with the exception of people who don't fit it because they're not desperate of course lol) are no less likely to be desperate for treatment of whatever sort they're seeking, whether that be just HRT, everything on offer or anything in between, than people who do. So I'm not sure "extremeness" is the right metric here. But yeah, dealing with psychiatrists is a terrifying experience, even when they turn out in the end not to share the gatekeeper ideology they're still basically Schrödinger's Gatekeeper until you know otherwise. And I'm not sure how it is in the US but in Britain, even then the ally psychiatrists have to walk a narrow line to avoid losing their license to practice (like Russell Reid did) too cos the General Medical Council is run by gatekeepers and idiots who only know what they've been told by the press. I've got an appointment in March, and I'm half dreading it.

I should state for the record here since I've criticised an aspect of the NHS so scathingly that if it wasn't for universal healthcare, I would most likely be dead and most of the people I care about almost *certainly* would, and definitely wouldn't ever be able to afford SRS regardless of whether I found a good psychiatrist. The problem isn't the concept of public ownership, its the fact that like the other nationalisations that took place as part of the post-war settlement, public ownership of the health system was never properly implemented and it was left under control of the same wealthy bureaucrats who ran it as capitalist enterprises rather than ensuring that the people who rely on them were in control.

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September 30th, 2013, 5:56 pm

Allie (Guest)

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@LilyFlareVII: the problem with that is that NOT transitioning also massively effects peoples lives, to the point that it often contributes to people for whom transition is necessary committing suicide. There's also the fact that nobody, if they're honest with themselves, is EVER 100% certain of *anything*, especially something intangible like the merits of an as-yet-unexplored course of action. So there's no legitimate reason to require more than 50.000001% certainty from you. And yes, I said from you - only the patient themselves can possibly be the arbiter of their own identity. And then there's also this thing called bodily autonomy, which stipulates that individuals have the right to do whatever the hell they want to their bodies EVEN IF its (usually subjectively) a bad idea so long as they understand the consequences and potential consequences and aren't hurting anyone else (see also drugs/alcohol/smoking, tattoos/piercings)

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September 30th, 2013, 6:04 pm

Allie (Guest)

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@Janna: not intruding at all IMO :) regardless of the dubiousness of the idea that being trans or seeking transition-related medical treatment is directly a mental health issue (although I do think psychological support is important for anyone whose life is undergoing what's often a massive upheaval, and HRT can also cause psychological and emotional changes that make people need to recalibrate their relationship with themselves and others), the parallels between this aspect of trans experience and the experience of people with mental health problems are clear. In fact as a trans person with multiple (unrelated or tangentially related) mental health problems myself I do worry about finding counsellors to talk to about those issues as well who I can be confident won't pathologise aspects of my identity that deviate from the norm

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October 1st, 2013, 12:59 am

LilyFlareVII

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@LittleLynn84: Ah, I didn't know about the 3 months wait. So yeah, you would think that after 3 months, they'd have gotten to know you well enough to decide if they should approve transitioning. I mean, I'm sure there are exceptions, like with all things, but heck, just working with a new coworker for a few months, I get to know them fairly well, and that's without them telling me their most personal information.

I guess when it comes to doctors, sometimes it takes a few tries to find a good one and not just one whose in it for the money. My husband and I are having trouble getting pregnant and he was telling me to go see my gynecologist. I mentioned how I don't really like going to him 'cause he doesn't take the time to listen to me. So my husband said I should find a new doctor. Well, while searching, I looked mine up on some physician rating sites and I was shocked by the horror stories posted about him. So now I've got a new OB and so far things are going ok.

It's a shame that greedy people cause others so much pain and frustration and make it difficult to trust the doctors who really are in it to help people.

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