dr marci bowers moves to california

[mrt (imported)]

This might be talking out of turn but having a standards of care for transexual folks seems (to me anyway) like a good idea. If you have surgery on demand you invite law suits from people who really DO have mental health issues and no Doctor can afford that.

Debate what the standard of care ought to be but don't just discount it. Ok?

Re men just wanting orchiectomy on demand I think you have a similar issue. And then there is a moral issue as well. Someone mentioned fertility and that may not seem like its important etc but... Some people may certainly have second thought later and thats at least worthy of consideration before anyone starts getting prepped for surgery.

[devi (imported)]

I was on the board of directors of a TS organization here in Seattle with Marci before she left to go to Trinidad. The problem for TS and castration surgeons is usually getting operating room privileges for the surgeries they want to perform. Dr Bowers maintained an office here and originally wanted to return her practice here, but was unable to find a hospital that was willing to grant operating privileges for SRS. Dr Metzler, another top SRS surgeon, was originally located in Portland, Oregon, but left for Arizona when the hospital where he worked was sold to another chain, and he was unable to come to a satisfactory agreement with the new owners.

A high percentage of the hospitals in this country are Catholic affiliated, and they forbid SRS and any surgery that eliminates fertility except for medical reasons. And many others are very conservative and fearful of malpractice. SRS has protocols and has become increasingly known, so a few more hospitals are willing to perform it, but non TS castration is often viewed as very risky. As we know, many regard the desire for castration as prima facie evidence of mental illness, and thus the surgery as highly likely to lead to malpractice. I suspect that this is the reason she dropped non-TS castrations.

Transward

The problem with the Harry Benjamin standards of care is that there is no attempt whatsoever to distinguish whether the individual is fertile and impotent or not. A person who is infertile and impotent should have no problem in getting an SRS but this is not the case. I remember being told at a young age that I would need to have testosterone injections so that I could grow a full beard and have a deeper voice. This was in order that I could then prove that even with all of the masculine traits I did not want to be a male but I would still not be able to have children. There is a disconnect here.

[mrt (imported)]

The problem with the Harry Benjamin standards of care is that there is no attempt whatsoever to distinguish whether the individual is fertile and impotent or not. A person who is infertile and impotent should have no problem in getting an SRS but this is not the case. I remember being told at a young age that I would need to have testosterone injections so that I could grow a full beard and have a deeper voice. This was in order that I could then prove that even with all of the masculine traits I did not want to be a male but I would still not be able to have children. There is a disconnect here.

Ok, but if you don't have this standards of care and just offer SRS at will who pays for the lawsuits when someone who has not thought this out or sat down with a therapist changes their minds? They sue claiming "harm" and I think a jury would hand down a ton of money. What about the man who is infertile has a bad relationship and wants an orchiectomy then changes his mind and wants to sue?

[micropenis (imported)]

Ok, but if you don't have this standards of care and just offer SRS at will who pays for the lawsuits when someone who has not thought this out or sat down with a therapist changes their minds? They sue claiming "harm" and I think a jury would hand down a ton of money. What about the man who is infertile has a bad relationship and wants an orchiectomy then changes his mind and wants to sue?

What we need is tort reform. A doctor should not be held liable after and adult signs an informed consent form.

[SplitDik (imported)]

What we need is tort reform. A doctor should not be held liable after and adult signs an informed consent form.

It's not that simple. The desire for castration is a mental disorder. Castration may still be the right and medically appropriate course, but it makes the idea of consent very difficult.

Also, it needs to be "informed" consent, and the doctor plays a part in that. Does a person really know what life after castration will be like?

I think it is right to have a standard of care that slows down the impulse, weeds out the truly crazy, gets people to have to go through counselling, etc. The trick is that we need the non-transsexual castration to be a more common and medically accepted course.

Anyway, I think it is not enough to just ask someone to sign a paper. It doesn't properly protect the doctor or the patient.

[Caith721 (imported)]

I think it is right to have a standard of care that slows down the impulse, weeds out the truly crazy, gets people to have to go through counselling, etc. The trick is that we need the non-transsexual castration to be a more common and medically accepted course.

I agree 100% with the above, specifically the final sentence.

Courts and jurors always believe the doctor should know more than the patient, and expect the doctor to work as a gatekeeper/keyholder to that magical doorway. Unfortunately, not all doctors are that well-informed, and the majority of jurors are sadly uninformed in matters such as this, having buried their heads in the sand their entire lives.

[devi (imported)]

Ok, but if you don't have this standards of care and just offer SRS at will who pays for the lawsuits when someone who has not thought this out or sat down with a therapist changes their minds? They sue claiming "harm" and I think a jury would hand down a ton of money. What about the man who is infertile has a bad relationship and wants an orchiectomy then changes his mind and wants to sue?

What I am saying is that if a person has defective and infertile testicles that have created intermittent hormonal imbalances leading to periodic hot flashes throughout their life and can also be potentially cancerous and wants them removed then they should be able to do so WITHOUT all that Harry Benjamin C-R-A-P-!-!-! They should not have to undergo testosterone therapy since this would not make them fertile anyway. When it comes to the Catholic hospitals they have no reason to go entirely by those bogus "standards of care". By Catholic doctrine itself this person CANNOT have children and so is every bit eligable to have them removed. However due to this other extenuating set of rules certain individuals get completely locked out of the system. It is not a simple binary matter of a "man" who wants to become a "woman" but that of a born-eunuch indiividual who cannot get help because of an arbitrary set of rules set forth by "concerned experts".

As for lawsuits, let the buyer beware. If someone signs all of the necessary consent forms per public notary for any type of purchase then they're on their own and that's the way it has been since the 1980s and the way it should be.

[Mac (imported)]

What we need is tort reform. A doctor should not be held liable after and adult signs an informed consent form.

The doctor should not be held liable

for the appropriatness of the procedure. However, the doctor should still be liable for making a medical mistake in the preformance of the procedure.

[Caith721 (imported)]

I think the root of the problem (in the US, at least) is the patriarchal nature of most male urologists who trained under/with older urologists. First, the majority of them are straight vanilla heterosexual people who cannot understand or appreciate the needs of intersexed or transgender patients. Second, the ages-old defensive fear of emasculation/castration runs through them. They cannot comprehend why anyone would desire the removal of their testicles. They immediately presume someone is mentally ill if they request orchiectomy. Third, the insurance companies and attorneys are not helping AT ALL. By instilling and publicizing the fear of malpractice and huge financial loss, they further their own business agenda.

We're fighting against a stacked deck, and it's only because "it's always been that way". As more openly GLBT physicians (http://en.wikipedia.org/wiki/Gay_and_Le ... ssociation) and lawyers (http://www.lambdalegal.org/) emerge, this will eventually change, but it's a painfully slow process.

[BossTamsin (imported)]

What I am saying is that if a person has defective and infertile testicles that have created intermittent hormonal imbalances leading to periodic hot flashes throughout their life and can also be potentially cancerous and wants them removed then they should be able to do so WITHOUT all that Harry Benjamin C-R-A-P-!-!-! They should not have to undergo testosterone therapy since this would not make them fertile anyway. When it comes to the Catholic hospitals they have no reason to go entirely by those bogus "standards of care". By Catholic doctrine itself this person CANNOT have children and so is every bit eligable to have them removed. However due to this other extenuating set of rules certain individuals get completely locked out of the system. It is not a simple binary matter of a "man" who wants to become a "woman" but that of a born-eunuch indiividual who cannot get help because of an arbitrary set of rules set forth by "concerned experts".

As for lawsuits, let the buyer beware. If someone signs all of the necessary consent forms per public notary for any type of purchase then they're on their own and that's the way it has been since the 1980s and the way it should be.

Quite honestly, I can agree with being allowed to refuse testosterone treatment. But as far as the rest is concerned...

Even if there's a 1% chance that you could regret it later, and so long as you're legally allowed to come back and sue the hell out of the doc for doing the procedure, it's not gonna be an 'on demand' type of surgery.

Shit like the McDonalds coffee incident, or any number of other court cases these days, only reinforces the opinion that it's better to turn away 1,000 people than to risk even one who might come back and sue. (I seem to recall hearing of someone, I think in Florida, who went so far as to fake psychiatric letters for SRS, only to regret it afterwards. They then successfully sued the doctor for performing the surgery, on the basis that the doc should have checked the letters more carefully. My Google-fu is failing me for a reference, however.)

Frankly, I can't see the medical establishment ever adopting anything other than a rigid checklist of some kind for these kinds of procedures. Partly to ensure that those who do get the operation know what they're getting into and are stable enough to understand the consequences, but mostly to cover their own asses in the likely event that one of their patients decides it was a huge mistake a couple years down the road.