More and more frequently, medical providers are offering an informed-consent model for healthcare in transgender individuals. This parallels the way cisgender people receive care in nearly all circumstances. The rate of "regret" in gender affirming procedures (including medical and surgical transition) is typically cited at less than or equal to 1% (Bustos et al., 2021), while the rates of regret across "all" elective but medically necessary surgeries in cisgender individuals is considered "relatively uncommon" at just over 14 percent (Wilson et al., 2017). Because of the extreme rarity of transition regret (which, when present, is four times more frequently due to external societal pressures than to internal identity realignment [Turban et al., 2021]), following the informed consent model is both the least stigmatizing way to support transition care and to offer evidence based care.
Unfortunately, until medical providers and surgeons, insurance companies, and even the WPATH SOC more eagerly embrace informed consent for transition care many of us will be forced to endure repeated, unnecessary, and often costly psychiatric evaluations of questionable benefit.
My commitment to you: I am not here to gate-keep, but to hold the door open to the medically necessary care that you require. I follow the GALAP letter writing pledge
(learn more here)
I DO
offer slots for free affirming letters; I will revise and update both free and paid letters as required at NO COST
(examples: name, gender, and pronoun changes since original issuance of letter; updating an expired letter) for a period of at least one year
after the initial evaluation. If there have been significant
changes in the details of the letter (physical or mental health, social or financial situations) that would impact the accuracy of the letter to the extent that a full re-assessment would be required, this would be completed at a significantly reduced rate.
References
Bustos, V. P., Bustos, S. S., Mascaro, A., Del Corral, G., Forte, A. J., Ciudad, P., Kim, E. A., Langstein, H. N., & Manrique, O. J. (2021). Regret after gender-affirmation surgery: A systematic review and meta-analysis of prevalence. Plastic and Reconstructive Surgery - Global Open, 9(3). https://doi.org/10.1097/gox.0000000000003477
Marrow, E. (2022). Breaking Cycles of Harm: Lessons From Transgender History for Today’s Clinicians. The Behavior Therapist, 45(6), 189. https://services.abct.org/i4a/doclibrary/index.cfm?category_id=25
Turban, J. L., Loo, S. S., Almazan, A. N., & Keuroghlian, A. S. (2021). Factors leading to “detransition” among transgender and gender diverse people in the United States: A mixed-methods analysis. LGBT Health, 8(4), 273–280. https://doi.org/10.1089/lgbt.2020.0437
Wilson, A., Ronnekleiv-Kelly, S. M., & Pawlik, T. M. (2017). Regret in surgical decision making: A systematic review of patient and physician perspectives. World Journal of Surgery, 41(6), 1454–1465. https://doi.org/10.1007/s00268-017-3895-9