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Nobody holds a gun to your head

by Helen Thu Oct 26th, 2006 at 09:33:14 AM EST

Psychiatrist rushed me into having sex change, says patient
This is a story in today's Guardian

http://www.guardian.co.uk/uk_news/story/0,,1931580,00.html

A former patient of the UK's best-known expert on transsexualism yesterday told an inquiry that she bitterly regrets changing sex and feels unable to live as either a man or a woman........................................

The patient told the panel she blamed Dr Reid for her unhappiness and gender confusion, claiming he had failed to investigate her history of severe depression, which included attempting to kill herself in a car crash, before approving her sex change. ............................

But the patient said the consultant psychiatrist never addressed these issues, nor obtained a second opinion. She had been an occasional cross dresser when she was a man, but had enjoyed a normal sex life with her two ex-wives. She said Dr Reid prescribed her with sex changing hormones at her first appointment and never checked that she was living full-time as a woman prior to her surgery in 1989. The sex change "fantasy" was shattered two days after the surgery when her father died, and she began to feel "ashamed"of what she had done.

The GMC is investigating a charge of serious professional misconduct against Dr Reid relating to five of his ex-patients, including Patient B. He is accused of breaching international guidelines on treatment of gender disorders by rushing patients into sex changing treatments.

Okay, full confession. Dr Reid was my psychiatrist too. So what I say in response to this story must pass through the filter of acknowledged bias.

As the title of this piece says, nobody holds a gun to your head and makes you have a sex change. You do it of your own free adult will. Contrary to what the proponents of the NHS scheme of testing their subjects under extreme social duress might claim, there is no test that can tell if you are genuinely transgendered. Nobody can apply any measure; technological, physiological or psychiatric that says "yes you are" or "no, you're not". Whatever they say, finally you have to take the patient's word that what they feel is true.

So, when this person says that Dr Reid handed her a prescription for hormones at their first meeting that would be true ; it happened to me too. That's the breach of international guidelines referred to above. They are called the Harry Benjamin protocols and describe "best practice". And they suggest that patients should live as a woman for three months before hormones are administered, certainly that is the regime adhered to by the NHS.

Personally I think the idea is monstrous, but my objections are so many and numerous that it would dilute the point of this diary.

However, Dr Reid uses hormones as a diagnostic tool. I had been experiencing a form of mental torture all my life, something akin to chinese water torture in the centre of my brain ever since puberty. Witihin six weeks of taking the hormones this sensation melted away like snow in spring. For the first time in my life I was able to look around and know that this was how normal people felt all the time.

Naturally when I saw Dr Reid at my nest appointment I mentioned this and he said that 70% of people to whom he gives a prescription never return, but of those who did, the overwhelming majority reported similar reactions to me. So, it seemed to me that Dr Reid had hit upon a diagnostic tool ignored and indeed disparaged by mainstream practitioners.

He worked in the private sector where, let's be honest, you pays your money and takes your choice and you only get what you pay for. I didn't pay for in-depth counselling, so I never got it. I have no idea whether it was offered to others, but I never sought it and so it was never offered. I'm not saying he was right in this, he had a pretty stark idea of duty of care and even I felt that it seemed to end on the line where the cheque got signed. The whole area is open to debate on both sides to be honest, but to criticise Reid on this is to ignore the greater problem.

So maybe some didn't get the care they needed, but they got what they wanted, or at least what they paid Dr Reid for. That's called private medicine. Life is not risk free and those of us who venture on the gender changing path do so knowing that there are several points on the journey from which there is no way back: Most especially the main operation itself. You sign forms agreeing that you understand what you are doing. You do so as an adult taking responsibility for youself. Dr Reid may have made it easy for the self-delusional to get an operation, but there is no system that is foolproof. If you really want to do this and can learn to lie to doctors, counsellors and, most especially, to yourself then you can get the operation, whatever system of checks is applied.

But it's for keeps. I simply do not understand why this person is complaining. Transgenderism is the only self-diagnosed condition as absolutely nobody can argue with you if you've convinced yourself. But self-diagnosis means you have to take responsibility for the consequences. And suing after the fact cos you were wrong seems pointless to me.

I feel sorry that they have come to regret this decision in their lives, but they entered into it of their own free will. It isn't Dr Reid's fault they did so and nothing he nor others could have done would have changed that. I hope they lose and lose big.


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Important perspective (and really appreciate your willingness to confide in us, Helen...)

"Once in awhile we get shown the light, in the strangest of places, if we look at it right" - Hunter/Garcia
by whataboutbob on Thu Oct 26th, 2006 at 09:56:41 AM EST
We discussed this on the train to Nottingham last weekend, and Helen mentioned one little detail which seems important and is missing here, and that is the claim that administering female hormones as a diagnostic tool is safe because female hormones have no harmful side effects on men for months.

Those whom the Gods wish to destroy They first make mad. -- Euripides
by Migeru (migeru at eurotrib dot com) on Thu Oct 26th, 2006 at 10:18:06 AM EST
It's more than a claim, tis a fact. I was told that I could take oestrogen for several months at very high doses (105 mg/day) before there was any chance of interfering with fertility.

Even after two years of them in the run-up to the op my surgeon mentioned that it still wan't too late to "recover" full virility if I so desired.

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu Oct 26th, 2006 at 10:24:07 AM EST
[ Parent ]
OMG.  I have to say, that is a lot of estrogen.  I'm not questioning the science; I'm sure you know more about it than I do, but I take .035 mg/day and that seems strong to me.  That's just wild.  

Those who can make you believe absurdities can make you commit atrocities. -Voltaire
by p------- on Thu Oct 26th, 2006 at 12:30:05 PM EST
[ Parent ]
I wrote that at work without recourse to the packet to check the amount. sorry, it's 105 micrograms ie .105 milligrams.

Still a huge dose. Comparison : teenage girls at maximum have a daily dose of about .085 milligram. And they cycle as low as .015. I'm at a steady .105 all the time; high on oestrogen.

But after 35 years as a guy, I deserve it.

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu Oct 26th, 2006 at 06:44:13 PM EST
[ Parent ]
Whew!  That makes MUCH more sense!

Those who can make you believe absurdities can make you commit atrocities. -Voltaire
by p------- on Thu Oct 26th, 2006 at 06:45:41 PM EST
[ Parent ]
Hee, I'm happy to give 105 milligrams a go, just to see. If I feel like this on my current dose, just imagine a 1000 times overdose. Sigh - yea it'd probably kill me stone dead or destroy my liver for a slow death, but we can only imagine.

keep to the Fen Causeway
by Helen (lareinagal at yahoo dot co dot uk) on Thu Oct 26th, 2006 at 06:52:07 PM EST
[ Parent ]
I thought it would be interesting to check normal testosterone levels for men.

It turns out they're measured in units of nanograms per decilitre of blood, which is a bit lateral, unit-wise.

Pausing to grab a calculator suggests that a normal level is around 25ug total, assuming 5L of blood.

These are incredibly powerful chemicals, aren't they?

by ThatBritGuy (thatbritguy (at) googlemail.com) on Fri Oct 27th, 2006 at 07:55:32 PM EST
[ Parent ]
Thanks for that insight.  I've met a couple of transgendered people who quite clearly did the right thing for themselves and are far happier and more comfortable in the correct gender.

I've also met a couple of people who are seriously messed up and I couldn't tell if that was the result of the mental trauma of having lived in the wrong gender all of their lives or whether they just were fucked up and thought that a gender reassignment would sort all of their problems out - like running away and getting a new identity in some fantasy world where everything is perfect.  

The point you make about people lying to themselves fits with that, because that form of manipulation is so hard to see through, especially if you can't take the time to unravel what is really going on in a person's head.

by In Wales (inwales aaat eurotrib.com) on Thu Oct 26th, 2006 at 10:39:19 AM EST
I've also met a couple of people who are seriously messed up and I couldn't tell if that was the result of the mental trauma of having lived in the wrong gender all of their lives or whether they just were fucked up and thought that a gender reassignment would sort all of their problems out

Yes, when you move into the tv/ts world you meet a lot of seriously damaged people. It genuinely feels like a form of torture and it can make you unhinged. It's very difficult to tease apart.

My view is that the NHS treatment, which involves living as a woman (ha !!) for 3 months before they give you hormones puts fragile people under too much stress. So when hormones are supplied, the person is too freaked out to notice if they have any effect. That's why I was grateful to Dr Reid that I was able to discover the effect for myself in my normal unstressed environment.

In this I think the NHS create too many false negatives, just as some say Reid creates too many false positives.

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu Oct 26th, 2006 at 10:55:26 AM EST
[ Parent ]
I notice a couple of inconsistencies... One is that the UK's best-known expert on transsexualism deviates from "internationally accepted best practice". On what basis does The Guardian call Dr. Reid the UK's best-known expert, and in that case how could his clinical practice of at least 20 years (as he treated both this patient in the 1980's in the same way as Helen recently) come as a shock to his colleagues?

The second one is the juxtaposition of

there is no test that can tell if you are genuinely transgendered. Nobody can apply any measure; technological, physiological or psychiatric that says "yes you are" or "no, you're not".

...

Transgenderism is the only self-diagnosed condition as absolutely nobody can argue with you if you've convinced yourself.

with
So, it seemed to me that Dr Reid had hit upon a diagnostic tool ignored and indeed disparaged by mainstream practitioners.


Those whom the Gods wish to destroy They first make mad. -- Euripides
by Migeru (migeru at eurotrib dot com) on Thu Oct 26th, 2006 at 10:49:59 AM EST
Well, he is one of the best known. He has been around for years and has served on the GMC's guiding committee for transexuality for about a decade.

However, it has also been known for some time that the GMC didn't like his dissention from standard practice as it implied criticism of the NHS process. This process which has been increasingly criticised from within the TG community and so this may have been a pre-emptive strike to quieten the  peasants. It has certainly been the common wisdom on the TG scene that the GMC were out to "get" Dr Reid; seems like they've found their silver bullet.

As for the second juxtaposition. The first is the conventional thinking. There are no tests. However Dr Reid has hit upon a solution that helps.

It is not a "classic" diagnostic tool because it doesn't work for all patients and neither is it independently verifiable. The consultant still has to take the patient's word that the effect was real.

However, for me, it was a wonderful proof that I was making the right decision. So it proved to me that I was right and gave me the confidence to continue a process towards what could be a very scary operation and take that decision without fear.

Anybody who enters into such a life-changing operation and didn't think long and hard about it is a fool. Fortunately, I had the knowledge that it was the right thing to do as a guide through my fears and concerns. Without that, I cannot say for certain I might not have turned back.

keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Thu Oct 26th, 2006 at 11:07:38 AM EST
[ Parent ]
As you've pointed out, it's indeed a cruel world out there and ultimately we are responsible for our own actions.  

I can swear there ain't no heaven but I pray there ain't no hell. _ Blood Sweat & Tears
by Gringo (stargazing camel at aoldotcom) on Fri Oct 27th, 2006 at 12:47:59 PM EST
[ Parent ]
I wonder whether the timing of this has anything to do with the fact that Dr. Reid retired recently (February this year according to the last paragraph in the Guardian article).

Those whom the Gods wish to destroy They first make mad. -- Euripides
by Migeru (migeru at eurotrib dot com) on Sat Oct 28th, 2006 at 07:17:07 AM EST
[ Parent ]


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