Thank you for clarifying that Kristoff.

QTKaatje (imported) wrote: Sun Jun 30, 2019 8:03 pm To be honest, every doctor is just concerned with covering his own ass. No single doctor on the planet would ever consider risking his career for your well-being, no matter if you're MtF or MtE. Even my psychologist told me "People just want to do this for a couple years, get rich and retire."

Even if you happen to be the most binary trans woman ever, you still need to go begging for it for over half a decade until you find someone who's willing to cooperate. It's ridiculous! It really doesn't matter if you've been having these feelings for multiple decades or not.

For now, DIY is really the only realistic option if you need help.

That's really not the case. More than 20 years past I walked into a surgeon's office in another country with cash in hand and explained what I wanted. It was taken care of the next week. The issue most seen here is (A) in the United States (B) folks will not save money and just pay out of their own pocket for the services and (C) people in the U.S. seam to think everything in life bad is somebody else's fault. Those three things have caused a climate where it is very difficult. There is no reason what-so-ever for DIY procedures. I know I will be argued with and told I'm out of order on this topic but it remains that a large number of the complaints are around the costs, and inability to get covered under insurance, which again is about the cost. In the end we are each responsible for our own lives.

Hello Kaatje,

as a trans woman you should be able to get proper treatment. Did you already try the vumc in Amsterdam? Here's at least one forum member who was successful there and got castrated, and he was mte, not mtf.

Begoneboy (imported) wrote: Wed Jul 03, 2019 5:47 am That's really not the case. More than 20 years past I walked into a surgeon's office in another country with cash in hand and explained what I wanted. It was taken care of the next week. The issue most seen here is (A) in the United States (B) folks will not save money and just pay out of their own pocket for the services and (C) people in the U.S. seam to think everything in life bad is somebody else's fault. Those three things have caused a climate where it is very difficult. There is no reason what-so-ever for DIY procedures. I know I will be argued with and told I'm out of order on this topic but it remains that a large number of the complaints are around the costs, and inability to get covered under insurance, which again is about the cost. In the end we are each responsible for our own lives.

Unfortunately there's no such thing as an elective orchiectomy in Europe (to my knowledge at least). I've done a lot of asking around for the past six months or so and haven't been able to find anything so far. If only I could just go som

T van Keel (imported) wrote: Wed Jul 03, 2019 5:58 am ewhere, borrow a load of money, and get it over with...

Hello Kaatje,

as a trans woman you should be able to get proper treatment. Did you already try the vumc in Amsterdam? Here's at least one forum member who was suc

cessful there and got castrated, and he was mte, not mtf.

I'm with Stepwork actually, but my insurance provider doesn't work with them (even though they did last year and everyone assured me everything was fine). How many years did it take him? Currently I'm looking at about 5+ years if I get a referral to vumc tomorrow and everything goes flawless.

Either way, I'm working my way through the system. I've worked really hard for the past couple years and I've managed to get my GID diagnosis, "green light" and changed my legal name and sex. However this doesn't really mean anything apparently... I need an endo to sign off on my 1+ year of DIY HRT, but there's no guarantee he's willing to do so or if I'm even going to be able to get an appointment this year. Oh and there's a waiting list for the actual surgery of at least six months as well. Also I'm unsure if I'm even allowed to pay for the procedure myself in case insurance doesn't cover it.

The hope of getting it done this year had kinda kept me going, but it's faded by now. The whole bureaucracy and pathologization process is so tedious and painful, I feel like nothing I'll ever do is enough.

kristoff wrote: Sun Jun 30, 2019 7:40 pm You should be aware that there are NO WPATH standards for MtE or anything to do with eunuchism except as it applies to MtF. The MtE standards are being worked on now and will be submitted for consideration, but they are NOT in place. Any doctor demanding WPATH qualified letters is asking for something that is non-existent at this time, as far as eunuchism is concerned. Some doctors will do MtE with a psych letter, but that has nothing to do with WPATH, and only has to do with the doctor concerned covering his ass.

I thought I might mention here that gender nonconforming identities have been recognized in the WPATH, and that they do--though not necessarily--experience gender dysphoria that may require surgical treatment. This was my path to surgery. (I identify as agender.) It's an important side-note that the old requirements don't apply to everyone anymore. That is, the WPATH standards don't require everyone seeking orchietomy or penectomy to spend a year in a female role taking feminizing hormones.

Which is not to say that we live in a perfect world where everyone both "got the memo" on that update and applies the standards of care in an unbiased manner towards all patients, with insurance covering all costs.

I would think someone identifying as a eunuch with he/him pronouns would still be qualified under the current standard as having surgery-treatable gender dysphoria, but I haven't been involved in the WPATH update process and advocacy for eunuchs.

QTKaatje (imported) wrote: Wed Jul 03, 2019 1:13 pm Unfortunately there's no such thing as an elective orchiectomy in Europe (to my knowledge at least). I've done a lot of asking around for the past six months or so and haven't been able to find anything so far. If only I could just go som

ewhere, borrow a load of money, and get it over with...

QTKaatje (imported) wrote: Wed Jul 03, 2019 1:13 pm I'm with Stepwork actually, but my insurance provider doesn't work with them (even though they did last year and everyone assured me everything was fine). How many years did it take him? Currently I'm looking at about 5+ years if I get a referral to vumc tomorrow and everything goes flawless.

Either way, I'm working my way through the system. I've worked really hard for the past couple years and I've managed to get my GID diagnosis, "green light" and changed my legal name and sex. However this doesn't really mean anything apparently... I need an endo to sign off on my 1+ year of DIY HRT, but there's no guarantee he's willing to do so or if I'm even going to be able to get an appointment this year. Oh and there's a waiting list for the actual surgery of at least six months as well. Also I'm unsure if I'm even allowed to pay for the procedure myself in case insurance doesn't cover it.

The hope of getting it done this year had kinda kept me going, but it's faded by now. The whole bureaucracy and pathologization process is so tedious and painful, I feel like nothing I'll ever do is enough.

There's a lot of trouble with all of this of course. Between Europe and America, the systems seem to be very different, and to make matters worse the systems themselves have all kinds of variations and loopholes. My instinct is to say that you /should/ be able to talk to a doctor about getting on an HRT program regardless if they sign off on what you've managed yourself. Being able to check hormone levels at regular intervals and make adjustments is going to be better for you.

You've also got the whole pain thing going on, though. I would say that in a reasonable world--which may not be where we are right now--you could ask to speak to a urologist (or whoever handles reproductive health and surgery there) about the pain issue you're experiencing and possibly you could also work with them regarding an orchietomy. If your insurance or doctors require a year of monitored HRT before they can cover/operate like that, perhaps at least you could deal with the immediate physical pain.

I wish I understood where the hangup is in your local medical system. It varies so much. Honestly as far as WPATH is concerned you don't even need hormone therapy.

Criteria for Genital Surgery

...

5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless

hormones are not clinically indicated for the individual).

...

From WPATH Version 7 (https://www.wpath.org/media/cms/Documen ... nglish.pdf ), Page 59

When I got my referral letters, the mental health professionals included that hormone therapy was not indicated in my case. (In fact, I take testosterone, the exact opposite of what would be indicated.) Perhaps you could speak to whomever you're getting referral letters from about it? If you already have a working relationship that might be a faster course than getting a new doctor involved. If they do require something 'signed off' maybe a regular GP could handle it? If they are checking and confirming hormone levels, that's a blood test a GP should be able to evaluate.

I will say that doctors seem quite eager to take your money if insurance doesn't cover your costs, but they'll usually want it up front.

QTKaatje (imported) wrote: Wed Jul 03, 2019 1:13 pm Unfortunately there's no such thing as an elective orchiectomy in Europe (to my knowledge at least). I've done a lot of asking around for the past six months or so and haven't been able to fin

dicklesstanuki (imported) wrote: Wed Jul 03, 2019 7:10 pm d anything so far. If only I could just go som

ewhere, borrow a load of money, and get it over with...

QTKaatje (imported) wrote: Wed Jul 03, 2019 1:13 pm I'm with Stepwork actually, but my insurance provider doesn't work with them (even though they did last year and everyone assured me everything was fine). How many years did it take him? Currently I'm looking at about 5+ years if I get a referral to vumc tomorrow and everything goes flawless.

Either way, I'm working my way through the system. I've worked really hard for the past couple years and I've managed to get my GID diagnosis, "green light" and changed my legal name and sex. However this doesn't really mean anything apparently... I need an endo to sign off on my 1+ year of DIY HRT, but there's no guarantee he's willing to do so or if I'm even going to be able to get an appointment this year. Oh and there's a waiting list for the actual surgery of at least six months as well. Also I'm unsure if I'm even allowed to pay for the procedure myself in case insurance doesn't cover it.

The hope of getting it done this year had kinda kept me going, but it's faded by now. The whole bureaucracy and pathologization process is so tedious and painful, I feel like nothing I'll ever do is enough.

This is the thread about the VUMC: http://forums.eunuch.org/showthread.php ... on-planned Maybe you can get in contact with Fixet and get some advice.

Things in Europe are still quite difficult, at least if you aren't Mtf or FtM. I can only speak about the situation in Germany. Here it is realtively easy to get hormone treatment and gender reassignment surgery as long as you are MtF or FtM. The procedure contains counseling with a therapist for at least 18 months before you are allowed to get surgery. Normally the health insurance covers all costs. One problem is there are long waiting lists, too. And when you are non-binary, things get really slow and difficult. I'm NB, but now after over 5 years I'm really close to the desired surgery. I got the necessary letter and my health insurance is currently in the process of checking wether they will pay for it, or not.

You got the GID diagnosis, so you should be able to get all desired treatments. I can't believe that transgender treatment in the Netherlands is so much worse than in Germany.

dicklesstanuki (imported) wrote: Wed Jul 03, 2019 7:10 pm There's a lot of trouble with all of this of course. Between Europe and America, the systems seem to be very different, and to make matters worse the systems themselves have all kinds of variations and loopholes. My instinct is to say that you /should/ be able to talk to a doctor about getting on an HRT program regardless if they sign off on what you've managed yourself. Being able to check hormone levels at regular intervals and make adjustments is going to be better for you.

You've also got the whole pain thing going on, though. I would say that in a reasonable world--which may not be where we are right now--you could ask to speak to a urologist (or whoever handles reproductive health and surgery there) about the pain issue you're experiencing and possibly you could also work with them regarding an orchietomy. If your insurance or doctors require a year of monitored HRT before they can cover/operate like that, perhaps at least you could deal with the immediate physical pain.

I wish I understood where the hangup is in your local medical system. It varies so much. Honestly as far as WPATH is concerned you don't even need hormone therapy.

From WPATH Version 7 (https://www.wpath.org/media/cms/Documen ... nglish.pdf ), Page 59

When I got my referral letters, the mental health professionals included that hormone therapy was not indicated in my case. (In fact, I take testosterone, the exact opposite of what would be indicated.) Perhaps you could speak to whomever you're getting referral letters from about it? If you already have a working relationship that might be a faster course than getting a new doctor involved. If they do require something 'signed off' maybe a regular GP could handle it? If they are checking and confirming hormone levels, that's a blood test a GP should be able to evaluate.

I will say that doctors seem quite eager to take your money if insurance doesn't cover your costs, but they'll usually want it up front.

The hangup is with gatekeeping unfortunately.

I've got a blood test from over a year ago showing me at castrate levels, but this simply won't suffice. They want to have an endo to verify this and write the referral, and it can't just be any endo either. It needs to be a "special" endo, one who's willing to work with trans people, of which there are only 9 in the entire country. I'm on the waiting list currently, waiting time unknown.

There's a couple thing I could do right now, but I'm totally at a loss and unable to decide:

1) Wait. Possibly indefinitely.

2) Force an orchi through CaCl, torsion, liver failure or the nuclear option (https://theoranskyjournal.wordpress.com ... uldnt-pay/). But this could make srs impossible if something goes wrong.

3) See an urologist. Orchi won't happen unless my life would depend on it, but I might be able to get an varicocelectomy. It's very likely they'll just send me home with ibuprofen however.

4) Get a letter online and go to Thailand, probably for full srs. I can afford Dr. Thep but I'm kind of reluctant considering his results.

5) Give up on transition altogether and take the easy way out. It's starting to get more tempting. I really should have started this process 20 years ago, when I still had the energy to sit through many years of gatekeeping.

T van Keel (imported) wrote: Thu Jul 04, 2019 9:17 am This is the thread about the VUMC: http://forums.eunuch.org/showthread.php ... on-planned Maybe you can get in contact with Fixet and get some advice.

Things in Europe are still quite difficult, at least if you aren't Mtf or FtM. I can only speak about the situation in Germany. Here it is realtively easy to get hormone treatment and gender reassignment surgery as long as you are MtF or FtM. The procedure contains counseling with a therapist for at least 18 months before you are allowed to get surgery. Normally the health insurance covers all costs. One problem is there are long waiting lists, too. And when you are non-binary, things get really slow and difficult. I'm NB, but now after over 5 years I'm really close to the desired surgery. I got the necessary letter and my health insurance is currently in the process of checking wether they will pay for it, or not.

You got the GID diagnosis, so you should be able to get all desired treatments. I can't believe that transgender treatment in the Netherlands is so much worse than in Germany.

Looking at Fixet, it still took almost 4 years. And that was back when the waiting list was still quite short.

I wasn't kidding when I said 5+ years.

* 2.5 year wait minimum before intake. Maybe longer.

* 8-10 months until start of diagnostic process.

* At least 6 months until diagnosis, but they're known to stretch this up to five times as long if you're unlucky.

* 4-6 months until you get to see an endo.

* 12 months of HRT, no matter how long you've been self-medding.

* Waiting list for surgeon unknown.

By that time, I'd be long gone.

The only advantage binary people have over NB people is a shorter diagnostic process, if they're lucky. And no, I can't get fast-tracked because my current diagnosis is from a competing clinic.

I lov

QTKaatje (imported) wrote: Sun Jun 30, 2019 6:33 pm e it when people tell me that "it's so easy".

Well, it's not.

Yea I *should* get all desired treatments, but so far I haven't got shit. What I did get is SSRI's and anti-psychotics after I came out to my psychologist a couple years ago, to cure my gender dysphoria without referral to a GIC.

And sure, my insurance *should* pay for everything, however they are free on making their own rules and regulations. Many people have to sue to get procedures insured.

Oh and part of the government wants to up the gatekeeping for srs now.

I don't know if it's worse than Germany or not, but it's really shitty.

I'd like to get treated before I die, but they've shown no intent in wanting to do so this far.

QTKaatje (imported) wrote: Fri Jul 05, 2019 1:37 am The hangup is with gatekeeping unfortunately.

I've got a blood test from over a year ago showing me at castrate levels, but this simply won't suffice. They want to have an endo to verify this and write the referral, and it can't just be any endo either. It needs to be a "special" endo, one who's willing to work with trans people, of which there are only 9 in the entire country. I'm on the waiting list currently, waiting time unknown.

There's a couple thing I could do right now, but I'm totally at a loss and unable to decide:

1) Wait. Possibly indefinitely.

2) Force an orchi through CaCl, torsion, liver failure or the nuclear option (https://theoranskyjournal.wordpress.com ... uldnt-pay/). But this could make srs impossible if something goes wrong.

3) See an urologist. Orchi won't happen unless my life would depend on it, but I might be able to get an varicocelectomy. It's very likely they'll just send me home with ibuprofen however.

4) Get a letter online and go to Thailand, probably for full srs. I can afford Dr. Thep but I'm kind of reluctant considering his results.

5) Give up on transition altogether and take the easy way out. It's starting to get more tempting. I really should have started this process 20 years ago, when I still had the energy to sit through many years of gatekeeping.

There is possibly another route to force hands open to you that I personally tossed at my physician after being rebuffed by a urologist he sent me to. The uro just shuffled me away with anti-inflammatories while dropping me as his patient so I know these frustrations well.

It's called microsurgical testicular denervation. Here's some info on it (the very article I gave to my physician to read in fact): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694241/ .

It's a reasonably well studied technique that was a gateway to a group of doctors who actually took the pain issue quite seriously in my own experience with this type of pain. I had that denervation done with a solid doctor, but when that failed (due to some physiological factors ) I was moved up to his department head (and his teacher) who saw no other option but to remove it. He ended up doing the other side when it went bad too, because it was clear a denervation was not going to work for me in the long term after I was involved in a research study to test botox nerve blocks (which worked very well, just not as long as he had hoped). I ended up in a medical database he was compiling with other researchers on the subject of testicular pain because of my being a trans woman and quite young to be having this kind of pain by the statistics (with my explicit permission of course ).

I come from knowledge of a healthcare system with a fair amount of rules as well (including a legendary GIC known as a bit of a gatekeeper's wet dream for various reasons like VUMC ), health systems navigation is a headache and a half. I had initially been trying to come out when I was rebuffed and sent away (which set me back at least a year on it), but months after being told there was nothing to be done I found that article on denervation and that's how I ended up with urologists who were actually worth their salt on the subject of testicular pain.