Help me come out to my psychiatrist!
July 24, 2015 9:56 PM Subscribe
I have an upcoming appointment with my psychiatrist at the end of the month. I want to tell her that I'm transgendered and want to start HRT. I have a general outline of the things I want to say, but I want to make sure I'm not missing anything significant. Snowflakes: Bipolar II, broke up with my partner about three-four months back. Insurance via N. California Kaiser.
I've been with this psychiatrist for about six or seven years now; our actual face-to-face appointments are once or twice a year, and that's mostly to confirm that my current meds are working fine, with little contact outside of that.
Despite this, she's a) the practitioner I've been seeing the longest, and b) the person who's been working with me on my mental health, so her buy-in would probably smooth things over in terms of hormone therapy through Kaiser.
With that in mind, there's two sticking points that I can immediately think of:
1: This has never come up in our discussions, mostly because I wasn't sure how that would affect the care I was getting for my bipolar disorder.
2: I had a long-term-ish relationship that recently ended (~3 years), and I'm worried that she might interpret that as some kind of 'you want to do this to feel closer to your partner' woo.
I have a rough draft of what I want to say - this isn't something I'll necessarily be reading aloud, but more of an outline:
Hivemind, have I missed anything big? Have you done something like this and have experiences to share?
I've been with this psychiatrist for about six or seven years now; our actual face-to-face appointments are once or twice a year, and that's mostly to confirm that my current meds are working fine, with little contact outside of that.
Despite this, she's a) the practitioner I've been seeing the longest, and b) the person who's been working with me on my mental health, so her buy-in would probably smooth things over in terms of hormone therapy through Kaiser.
With that in mind, there's two sticking points that I can immediately think of:
1: This has never come up in our discussions, mostly because I wasn't sure how that would affect the care I was getting for my bipolar disorder.
2: I had a long-term-ish relationship that recently ended (~3 years), and I'm worried that she might interpret that as some kind of 'you want to do this to feel closer to your partner' woo.
I have a rough draft of what I want to say - this isn't something I'll necessarily be reading aloud, but more of an outline:
I am transgendered. I have a feminine gender identity, and I'm telling you this because I plan on pursuing hormone therapy, and would prefer to do so with you as part of my current care through Kaiser.I'm debating including something about the fact that I'm willing to go elsewhere to receive treatment, but I don't know if that would be too aggressive/confrontational.
I realize that this coming at you from out the blue - this is something I've been growing towards for over ten years, that I never brought up because I was afraid that doing so would detract from the care I was already receiving.
I realize that this also comes soon after some emotional events in my life. I have given this consideration, both on my own and with a therapist, and come to the conclusion that this is not related.
I understand that Kaiser already has clinics that handle gender therapy, and I would appreciate a referral.
Hivemind, have I missed anything big? Have you done something like this and have experiences to share?
First thought: Strike the "-ed" in transgender. You are a transgender woman, it's a noun not a verb. (Not trying to be pedantic, but I think starting off strong with your words will help a lot)
Second thought...will come in another answer because I submitted this one by accident. Dammit.
posted by Annika Cicada at 11:27 PM on July 24, 2015
Second thought...will come in another answer because I submitted this one by accident. Dammit.
posted by Annika Cicada at 11:27 PM on July 24, 2015
Northern California Kaiser has good resources for transgender care; they have a clue and you are unlikely to run into issues (some general primary care doctors are less cluefull than others, but most Kaiser locations have or can refer you to a specialist. It will depend on your location.) You will very occasionally run into someone who is under the mistaken impression that transgender care is excluded from your plan, but that's been illegal since 2012, so correct them and move on. Sometimes it takes longer than you want, but that's insurance for you.
I think your script is great-- you might want to mention that you refrained from bringing it up due to issues around medical coverage and transgender exclusions, which are now a thing of the past. That worked for me, and it was true. The SF Kaiser gender clinic folks mentioned to me that since exclusions no longer apply in California, and since Obamacare expanded who can get insurance, they're actually kind of struggling to keep up with demand! So you wouldn't be the only one waiting to bring it up until transition was safe and accessible. Similarly, it makes sense that you would want to scope out your doctor's general level of knowledge and friendliness and your insurance's options before bringing it up, just in case.
It's also responsible and smart to do some of your own research as part of your self-discovery, so really they're not going to dig too much into the "why now?" aspect. A transition is a pretty big decision, plus it's a stigmatized decision, so most people are going to make damn sure it's for them before they do any actual transitioning. This is all to say that it would have been surprising if you brought it up on your first day at Kaiser (but certainly not impossible or unheard of.)
I'm guessing you also had other fires to put out on the mental health front, so you did that and here you are, putting out a more slow-burning fire. I'm happy for you that you're healthy enough to take care of this; I had to deal with depression and family of origin issues myself before I could address the nagging gender feels I was trying not to think about, but I'm glad I did the work I did in the order I did it. It's good you're taking your time to be stable first and manage your health one thing at a time.
And one last thing: be really assertive. While this isn't yet an emergency, it's very important to take care of properly. Do not take no for an answer. Leave you next appointment with an appointment with the people who will set you up with HRT and/or in-house therapy. Tell yourself: this is medically necessary. Transition is a medical need as part of a balanced health care plan.
posted by blnkfrnk at 11:32 PM on July 24, 2015 [7 favorites]
I think your script is great-- you might want to mention that you refrained from bringing it up due to issues around medical coverage and transgender exclusions, which are now a thing of the past. That worked for me, and it was true. The SF Kaiser gender clinic folks mentioned to me that since exclusions no longer apply in California, and since Obamacare expanded who can get insurance, they're actually kind of struggling to keep up with demand! So you wouldn't be the only one waiting to bring it up until transition was safe and accessible. Similarly, it makes sense that you would want to scope out your doctor's general level of knowledge and friendliness and your insurance's options before bringing it up, just in case.
It's also responsible and smart to do some of your own research as part of your self-discovery, so really they're not going to dig too much into the "why now?" aspect. A transition is a pretty big decision, plus it's a stigmatized decision, so most people are going to make damn sure it's for them before they do any actual transitioning. This is all to say that it would have been surprising if you brought it up on your first day at Kaiser (but certainly not impossible or unheard of.)
I'm guessing you also had other fires to put out on the mental health front, so you did that and here you are, putting out a more slow-burning fire. I'm happy for you that you're healthy enough to take care of this; I had to deal with depression and family of origin issues myself before I could address the nagging gender feels I was trying not to think about, but I'm glad I did the work I did in the order I did it. It's good you're taking your time to be stable first and manage your health one thing at a time.
And one last thing: be really assertive. While this isn't yet an emergency, it's very important to take care of properly. Do not take no for an answer. Leave you next appointment with an appointment with the people who will set you up with HRT and/or in-house therapy. Tell yourself: this is medically necessary. Transition is a medical need as part of a balanced health care plan.
posted by blnkfrnk at 11:32 PM on July 24, 2015 [7 favorites]
Second thought: much like what jbenben says, you aren't appealing to authority.
What you are doing is asking your counselor to represent you according to WPATH standards. I suggest rewriting this to be something along the lines of:
"I'm transgender. I want to start HRT. if you are not comfortable writing a letter for me can you recommend a counselor you trust?"
I had to do that in Seattle and Austin with 2 different counselors. The one in Seattle said "yeah!" The one in Austin said "I don't think I can do that". My story of how I started HRT is a bit convoluted and takes time to write out. But let me say that you are well within your right to not be asking for permission here. It's a common thing to feel overwhelmed and at the mercy of the standards of care, but you have more control over your destiny than you may think you do.
I would recommend overall though, that finding a really good gender counselor in your area (if that's even available) will pay off in dividends over the long run with the changes and challenges you'll experience on HRT.
If you want to talk privately you can MeMail me. I have a lot experience navigating the WPATH standards and can offer up what I learned along the way.
posted by Annika Cicada at 11:38 PM on July 24, 2015 [3 favorites]
What you are doing is asking your counselor to represent you according to WPATH standards. I suggest rewriting this to be something along the lines of:
"I'm transgender. I want to start HRT. if you are not comfortable writing a letter for me can you recommend a counselor you trust?"
I had to do that in Seattle and Austin with 2 different counselors. The one in Seattle said "yeah!" The one in Austin said "I don't think I can do that". My story of how I started HRT is a bit convoluted and takes time to write out. But let me say that you are well within your right to not be asking for permission here. It's a common thing to feel overwhelmed and at the mercy of the standards of care, but you have more control over your destiny than you may think you do.
I would recommend overall though, that finding a really good gender counselor in your area (if that's even available) will pay off in dividends over the long run with the changes and challenges you'll experience on HRT.
If you want to talk privately you can MeMail me. I have a lot experience navigating the WPATH standards and can offer up what I learned along the way.
posted by Annika Cicada at 11:38 PM on July 24, 2015 [3 favorites]
that I never brought up because I was afraid that doing so would detract from the care I was already receiving.
I don't understand exactly what you're saying here, but I wonder, might they hear this as an implication that you think they're biased against transgender people? Just a thought.
posted by salvia at 11:55 PM on July 24, 2015 [1 favorite]
I don't understand exactly what you're saying here, but I wonder, might they hear this as an implication that you think they're biased against transgender people? Just a thought.
posted by salvia at 11:55 PM on July 24, 2015 [1 favorite]
I have a friend who hit peri-menopause and it changed up her meds. While there is some concern, there may be some hidden benefits, AND having a read on external hormonal dosages could be a distinct plus, as endocrine systems don't talk to you like a prescribing physician. Go into it with an open mind.
posted by childofTethys at 6:25 AM on July 25, 2015
posted by childofTethys at 6:25 AM on July 25, 2015
why does this have to be so fast? maybe this is an american medical thing i don't understand. but if it were me, with the psychiatrist i see sometimes, i'd be going to him with an approach much more like "ok, i feel like this. give me some advice." then i'd think about what they said. then i might take some action.
in a sense i'm echoing a sentiment above - they're serving you. i go to this guy because he's smart and he helps me. if he didn't he wouldn't get my money.
but the flip side of that is that he's smart, sees stuff i don't, and helps me. so i listen to him. we are a team whose aim is to make me better.
in contrast, you seem to be fighting your psychiatrist (or at least, getting ready for a fight). why on earth do you have a psychiatrist you don't trust or want to share things with? maybe this is the medical system issue i mentioned above.
or maybe you're worried that they won't be receptive to the idea of being transgender? again, if so, why are you seeing them? my guy has always been unfailing neutral. i can chat to him about illegal whatever and he doesn't bat an eyelid. sure, sometimes he questions me. and sometimes he's right.
anyway, i think you should change psychiatrist before you do anything else. get someone you trust and can share a major change like this with. then explore it and move forwards.
posted by andrewcooke at 7:33 AM on July 25, 2015 [2 favorites]
in a sense i'm echoing a sentiment above - they're serving you. i go to this guy because he's smart and he helps me. if he didn't he wouldn't get my money.
but the flip side of that is that he's smart, sees stuff i don't, and helps me. so i listen to him. we are a team whose aim is to make me better.
in contrast, you seem to be fighting your psychiatrist (or at least, getting ready for a fight). why on earth do you have a psychiatrist you don't trust or want to share things with? maybe this is the medical system issue i mentioned above.
or maybe you're worried that they won't be receptive to the idea of being transgender? again, if so, why are you seeing them? my guy has always been unfailing neutral. i can chat to him about illegal whatever and he doesn't bat an eyelid. sure, sometimes he questions me. and sometimes he's right.
anyway, i think you should change psychiatrist before you do anything else. get someone you trust and can share a major change like this with. then explore it and move forwards.
posted by andrewcooke at 7:33 AM on July 25, 2015 [2 favorites]
You mention a therapist and you mention the need for a referral. Are you sure the referral needs to come from a psychiatrist? My therapist, who is a LCSW and not a doctor, wrote me the referral to my endocrinologist. I would ask whoever you're going to be getting the HRT from.
But yeah, I agree with Annika et al that you don't need to justify anything or come off as permission seeking. I definitely had the mindset that no one would believe that I was really transgender, or that they'd think it was because I was depressed or recently divorced. But that has not been true. Maybe it is different for MTFs but people have taken me at face value.
I would say something like this - "I want you to know that I am transgender and I am pursuing HRT after discussing it with my therapist. I need you to know so that you are aware of any interactions that may occur with my current medication." (Note: I have no idea if there are known interactions with HRT so this last sentence may not even apply.)
It would be wildly irresponsible for her to refuse treatment based on your gender identity (possibly even illegal in CA) and that is something you could report to the medical board, so it is almost certainly not going to happen. If you want to feel more secure, have a backup plan for obtaining your psych medication while you find another psychiatrist, perhaps from a PCP.
Best wishes! You are doing a great thing for yourself.
posted by AFABulous at 12:36 PM on July 25, 2015
But yeah, I agree with Annika et al that you don't need to justify anything or come off as permission seeking. I definitely had the mindset that no one would believe that I was really transgender, or that they'd think it was because I was depressed or recently divorced. But that has not been true. Maybe it is different for MTFs but people have taken me at face value.
I would say something like this - "I want you to know that I am transgender and I am pursuing HRT after discussing it with my therapist. I need you to know so that you are aware of any interactions that may occur with my current medication." (Note: I have no idea if there are known interactions with HRT so this last sentence may not even apply.)
It would be wildly irresponsible for her to refuse treatment based on your gender identity (possibly even illegal in CA) and that is something you could report to the medical board, so it is almost certainly not going to happen. If you want to feel more secure, have a backup plan for obtaining your psych medication while you find another psychiatrist, perhaps from a PCP.
Best wishes! You are doing a great thing for yourself.
posted by AFABulous at 12:36 PM on July 25, 2015
why does this have to be so fast? maybe this is an american medical thing i don't understand. but if it were me, with the psychiatrist i see sometimes, i'd be going to him with an approach much more like "ok, i feel like this. give me some advice."
Because in the US under many medical regimes, psychiatrists are for drug dispensing and monitoring, while therapy is done by psychologists, psychotherapists or others holding related qualifications. The OP has indicated she has a such a therapist already.
posted by DarlingBri at 2:41 PM on July 25, 2015 [2 favorites]
Because in the US under many medical regimes, psychiatrists are for drug dispensing and monitoring, while therapy is done by psychologists, psychotherapists or others holding related qualifications. The OP has indicated she has a such a therapist already.
posted by DarlingBri at 2:41 PM on July 25, 2015 [2 favorites]
I realize that this also comes soon after some emotional events in my life. I have given this consideration, both on my own and with a therapist, and come to the conclusion that this is not related.
The only thing I'd change about the script is here. I don't think you need to explain that it's not related to recent events, you mention in the line above that you've been moving toward this for over ten years. I get the urge to be as prepared as possible to explain, but it might be better to take an approach like - while you have had some recent upheaval it didn't change how you felt about yourself and where you need to be, and this is something you were going to pursue regardless.
posted by bile and syntax at 7:01 AM on July 26, 2015
The only thing I'd change about the script is here. I don't think you need to explain that it's not related to recent events, you mention in the line above that you've been moving toward this for over ten years. I get the urge to be as prepared as possible to explain, but it might be better to take an approach like - while you have had some recent upheaval it didn't change how you felt about yourself and where you need to be, and this is something you were going to pursue regardless.
posted by bile and syntax at 7:01 AM on July 26, 2015
Mod note: From the OP:
Thank you all SO much! I took your advice to heart and ended up calling the Kaiser people who handle gender transition, and they confirmed that they could find me someone to provide a referral independent of my psychiatrist.posted by restless_nomad (staff) at 10:53 PM on July 30, 2015 [5 favorites]
Fortunately, that wasn't needed. My talk with my psychiatrist went even better than I'd hoped, and she's helping me set up a referral to endocrinology.
I feel AMAZING.
This thread is closed to new comments.
This person works for you. They are NOT some random authority figure you must convince of anything. Should they be bullshit enough to deny you the medical treatment you want, or otherwise challenge you and put up obstacles, you can go see someone in your insurance network that is OK with your treatment requests.
Does that help you? It should!
You do you. Don't ask permission. Seek out what you want. Don't apologize. You do you.
posted by jbenben at 10:55 PM on July 24, 2015 [5 favorites]