Prequel: Gathering information for an article I am writing on Transsexual Regretters

This discussion will tie into something I've recently taken an interest in and am writing an article about; transsexual regretters. What role, if any, does the  informed consent model contribute to the rate of transsexual regretters? I am looking at statistical outcomes for my article. If 5% of people who have come to regret their decision to transition and have grs, that becomes significant and can become an argument against informed consent, or even providing the means to have access to HRT and GRS via WPATH SOC.
Do you believe this is a significant issue? To be honest, and in the interest of full disclosure, I advocate for the WPATH SOC and am a member of WPATH.  I am a psychotherapist who is post transition and pre op. I have chosen to adhere to the SOC despite having the means to circumvent the process because I believe that WPATH's SOC is a reasonable and thoughtful approach for people coping with our issues. I am, however very open to other points of view. I don't believe I have the lock on what is "correct" or "right".
When I look at the recent study by NCTE and their statistics on substance abuse, poverty, victimization and attempted suicide rates (> 30%) which are magnitudes above the general population, then read what those who regret transitioning and their perspectives, I recognize that something significant has occurred and there seem to be far too many who think they made a terrible mistake.

Many of those who regret their decision to transition do not take much personal responsibility for their tragic regrets. They indict a system that allows almost no review in the process they undertake and see tragedy as a result.

Others rail against any kind of system that compels a person to engage in a process of examining their motives and potential for poor or disastrous outcomes in the hopes that system will provide better outcomes for those who transition from a biopsychosocial perspective.

I am exploring why those who regret their choices are so vocal in opposition to allowing others to proceed in this process and why whatever decisions they made to transition ended in such tragic results.

There are no clear compelling arguments for the extremes of each position here. What is your opinion?

Do It Yourself Hormones: Is this a good idea?

I had a nice discussion with a lovely woman from Florida who came to my workshop at Southern Comfort two weeks ago. She had been on do it yourself hormones for awhile, stopped taking them and went back on them, but after she heard my comments, she changed her mind and was going to look into getting prescriptions and medical monitoring of her hormones.

I am someone who is not an advocate of doing it yourself, also sometimes known as D-I-Y. But I am also someone who has tried do it yourself, albeit a long time ago and it was only for about 3 or 4 months. I hope that this article will help people to reconsider the D-I-Y route and seek medical supervision.

My personal adventure with D-I-Y does not contain a horror story and I am not going to paint dire pictures of certain doom, illness or death, but there are potentially serious health complication that the D-I-Y person should be aware of and at least take some reasonable steps to minimize the potential for harm that exists with D-I-Y.

I have said before and I will say again, hormones are not playthings. Misuse of hormones can lead to heart, kidney and liver damage. They have the potential to raise blood pressure and cause heart attacks and strokes or fatal embolisms. Some people are not candidates for HRT because of other pre existing serious heart problems.

One of the most serious problems is that the pharmacies that one can obtain these hormones from do not require prescriptions. There is no guarantee that the drug you have purchased was manufactured with adequate standards to insure that the two milligram estradiol tablet actually contains 2 mg of estrogen. It may contain 2.5 mg or it might not even contain 1 full mg if estradiol. You just don't know what you are really getting. When you get a perscription filled, you are buying hormones that have been manufactured under rigorous standards and can feel safe that you are actually getting what you expect to be getting.

Many people who do it themselves ignore the need for regular blood testing every 6 months. This is important for many reasons. One reason is this is how physicians determine that your organs are not being negatively impacted by what you are taking. It confirms that you are getting proper amounts of hormones so that you can get the most benefit from taking them. You just might not be getting the serum levels of hormones up to where they should be in order to be most effective! It allows you to be aware of your cholesterol levels which can affect your heart and arteries and your liver. Adjustments can be made with other drugs, you don't necessarily have to cut back or eliminate HRT with this information if things aren't in balance.

One of the many reasons people don't go to their personal physician is because they continue to experience guilt and shame over experiencing gender dysphoria. That is something that occurs frequently and needs to be addressed, I've been there. I had literally had an old country doctor who was getting near retirement. My own guilt and shame at the time prevented me from going to him and telling him about myself. My solution was to ask my gynecologist to refer me to a female doctor as I'm not keen on having men seeing my body. So now I have a female primary care doctor who I can go to and talk to without feeling ashamed of myself. Whatever you have to do to get rid of the guilt and shame to have a health care provider you trust, please do it. You deserve nothing less than quality health care!

Another thing to consider is that you may be paying way over what you should for those black market hormones. Did you know that a prescription for 90 days of the maximum therapeutic dose of estradiol is $36.00 (U.S.) at Walmart, Kmart, Kroger or Martins for example of stores in my area? That's $12 dollars a month! That's dirt cheap. Most insurance companies' co pays would be higher than that. So isn't it worth dealing with your fears to find a competent practitioner you can trust? Then you know you are getting what you are supposed to be getting. How much is Spironolactone? $18.00 for 90 days at the recommended highest dose. Some of us take progesterone and there is some debate whether it is at all helpful or not in breast development. Generic progesterone is also inexpensive. My gynecologist prefers Prometrium because it is bioidentical to women's natural progesterone. It is expensive though. The maximum dose runs me a bit over $100.00 a month. In 6 more months I'll make a decision whether this is benefitting me or not in terms of breast development. If after 18 months on it and the results aren't that much, I'll likely discontinue it.

"Sherri, you don't get it, do you? I live in BFE (that is a remote place in Egypt). There is no doctor where I live who I can trust to go to or is willing  to prescribe HRT. I know this for a fact because I have called around."

Ok fair enough, not all health care professionals are as enlightened as I am or as enlightened as the ones who take care of me. I'll grant you that.

At least, go get your blood work done every six months, Please, please, PLEASE! get your liver and kidney functions tested and cholesterol too, even if you choose not to tell the doctor you are doing it on your own. We have a term for that. It's called HARM REDUCTION.

Speaking of harm reduction, being a member of WPATH, we strongly advocate harm reduction. What does that mean? It means that anyone who comes to see me on DIY hormones goes to the head of the class. I issue a letter of referral and give my patient the names of two, soon to be three doctors in my area who are willing to prescribe HRT for trans people. I give this letter on the second visit.  Harm reduction is the overriding principle and it is a principle supported by the WPATH standards of care. I want my patients to be safe!

Please consider these thoughts when you decide whether you decide to go see a doctor or do it yourself. You only get one shot at HRT and it has to be done right so that all we have to endure pays off on our journey to be who we truly are! What good is it, if one ruins her health on the journey?

I'm Back From Southern Comfort Conference: Reflections and Observations

I'm home again from the Southern Comfort Conference. Well, actually I came home a week ago last week on Sunday. I was quite tired, had to work the next day and I've gone to bed fairly early each night until last night night when the Gods of Football television decreed that the University of Alabama begin their game at 9:15 P.M. local time, so I find myself tired again this morning and did not participate in my intentional community's service. Perhaps I will get back on track with that next week. I hope so, as I always feel better for having attended.

As always, I truly enjoyed my time at the conference. The Crowne Plaza Ravinia in the Perimeter area of Atlanta is simply a gorgeous venue and conveniently located across from a very nice mall and several very fine restaurants. Other shopping is convenient as well in the area and you won't get lost.

My workshop was well received and I'm always both flattered and humbled that people enjoy my presentation and I always give an historical context for the present state of the WPATH standards of care, as well as what the standards actually do state. There is a lot of myth about the standards of care that continues to abound. It confuses both people who are wanting to approach a transition and be healthy, and puts so many people off who resort to illegal sources to obtain hormones for a number of reasons. I'll be writing more on this topic next time.

Chloe Prince had a reception for Pink Essence members which was well attended and very lovely. She announced that she is launching a new web enterprise called TrueEssence.org. It's purpose is to be a one stop website to help people find the various resources we all need on our gender journey. This is a much needed service to our community and I wish her all the success in the world with this venture!

I didn't attend many workshops myself this time. Many of the topics I've heard on a number of occasions. This is not to say I am above it all or that there isn't more to learn, because there is always more to learn and I need to stay current so that I can help others better and for my own needs at this late time in my transition. I attended a workshop on transitioning in the workplace that was excellent and got a few ideas about better ways to go about taking this up with the workplace administration. The other workshops I attended were on sexuality for the male to female transsexual taking hormones and one on coping with and resolving internalized transphobia. That is a very important topic as even those of us have dealt mostly with coming to terms about who we are and coming to terms with the people in our lives, can sometimes feel a degree of doubt or guilt and shame creep into the back of our minds. Resolving internalized transphobia isn't like completing a contest, or arriving at a destination, just like the process of transitioning, it is a journey.

My purpose this time, besides the main purpose of presenting my workshop, was to get some time to destress from my practice of psychotherapy which has been very busy and undergoing a lot of changes with the changes coming with the new health care systems. I wanted to get a massage for a back problem and for the holistic health benefits from a therapeutic massage. So the good news is that I got my back straightened out after almost a month and I was able to return to playing golf this week. I played twice in fact! On Thursday I played 9 holes with a friend after work and then yesterday I played 18 holes by myself. I played well for my level of skill on both occasions. I'm playing on a course I've never played before this Wednesday afternoon that is rated #36  in difficulty in the United States. I'm pretty sure I will stink it up, but I never take the game seriously, don't get angry when I don't play well and generally have a fun time and get rid of my stress.

Another purpose was to network with other psychotherapists, gender surgeons, and other allied health care professionals who I know. I took the opportunity to meet some other professionals I hadn't met before.

Then of course one of the biggest reasons is to see old friends I don't to see more than a few times a year and some I only see once a year. Wonderful people and I wish I could see them more often. I have friends like them all over now because of the opportunity to give the workshops in various places.

One of the things I enjoy a great deal is the opportunity to make new friends and each time I go to give a workshop, I meet new friends and look forward to seeing them the next time I'm in their city. That's always a lot of fun for me!

One of the things I reflected on is the debate on gender identities and I recently wrote on that topic here. The article is called The Dialectic of the Gender Continuum. One of the things I wrote mentioned that various gender identities are all valid, though not necessarily having anything in common with each other. Before I went to the conference, I wrote another article about the important role conventions such as Southern Comfort play for our communities. Some people I know expressed that they no longer go to these conferences because they feel they have nothing in common with others who have different gender identities. They feel clearly different from people with other gender identities and don't wish to socialize with them. I find that attitude disappointing. While I personally don't feel as if my identity has common elements as a woman of transsexual experience, I don't like the idea that I shouldn't socialize with others because they are different. I think if those who segregate themselves from others with different gender identities were to reflect on this attitude, they might be shocked to realize that that notion is no different from segregation due to racism and that they would not find those attitudes to be attractive within themselves. I'm not going to like every person who identifies as a cross dresser, fetishistic transvestite, transgender, or whichever identity someone may claim, but I am going to like some of them and I would not wish to not have the opportunity to make a new friendship. I've found that I never have enough friends and that all my friends, close or not, have something to offer me or teach me. I'm pretty shy, people wouldn't guess that, but I do like people.

Along this same theme, I heard the attitude shared that many younger people at the conference philosophically don't like the idea of having a gender identity at all. They identify as gender queer or other similar labels and they would deny everyone their own right to a gender identity as male or female in a society of their own design. I find it interesting that they would segregate themselves and impose a societal code that denies others of their own gender identity. You see this theme in much of feminist academic writing and in the presentations these individuals give at workshops. They want to impose the use of new language in the use of pronouns that deny the existence of gender identity. Ironically, these folks seem to be a small proportion of those in the gender community. I can never see myself identifying as anything than "female" or "woman" and would feel oppressed by a society that denies me my own identity, much as these individuals feel oppressed by a society that expects them to have a gender identity of either male or female. I find that rather ironic that they would choose to subject others to the same oppression they seek to be freed from.

I hope that the gender communities will come to accept others with different identities than their own and not feel threatened by those identities that are different than their own, just as we expect the dominant culture to accept us and respect our place in an open and free society. Sometimes I think the dominant culture is way beyond us in acceptance of us when we can't be tolerant of others with different identities in our own community. What do you think?

Trans Conventions: Why Should You Go to One?

Each year, there are opportunities to attend one or more trans conferences around the country. As time has gone by, there are more and more conferences available to attend regionally, providing opportunities to learn more about ourselves, meet people like ourselves, have fun and find out about options for medical and aesthetic care. At some conventions there are also continuing education tracks available to educate professionals such as myself. We are taking the responsibility for finding professionals who can educate other professionals who are interested in helping us and providing these important opportunities. I have both given workshops to other professionals and received a substantial amount of continuing education over the past two years. That has allowed me to solely focus on studying sanctioned curricula by my profession and teach to other professionals. Because of these opportunities, I have completed 73 hours of continuing education in the last two years on top of the self directed studies that I have been engaging in over the past 16 years. That is equivalent to 4.5 semester hours in a graduate program.



Since 2009, I have been attending conferences to offer workshops on the history of mental health treatment of transsexualism and what is the present state of the art in transgender care. I do my best to provide education to other professionals and seek out the best education opportunities that I can find, as well as unravel the misconceptions about the WPATH Standard of Care, and myths that abound in the gender community to the members of our community.

I have not been to all the conferences available to go to, but have been going to Southern Comfort Conference each year. Southern Comfort is the largest conference I have attended and is one of the longest running and largest conferences in the U.S. This year will be my fourth time presenting a workshop there. This conference is the most dear to me because Southern Comfort gave me my first opportunity to present a workshop on my area of specialization.



 I have given a workshop at the Trans Philadelphia Health Conference, which is the largest health conference in the world on the topic of transgender care and last year chaired the mental health workshop selection committee for this conference. I have also attended the Keystone Conference in Harrisburg, Pa., TransOhio Conference in Columbus, and Chicago Be- All and I have to say, I have enjoyed them all. Besides the opportunity to give or get these educational opportunities, I have treasured the friendships I have made at the conferences and the opportunity to spend time with many wonderful friends that I have across the nation thanks to the Internet and through the past four years that I have been a member of Pink Essence. I attended five conferences last year.

What can you expect at these conferences? Be prepared to meet all sorts of people from every walk of life and from all over the U.S. It is not unusual to meet people from all over the U.S.



You will have an opportunity to attend workshops on various topics that include counseling, etiquette, how to move in a feminine manner, fashion styling, medical health issues such as hormone regimens, aesthetic and gender reassignment surgeries, voice therapy, how to transition at work, improving family and spousal relationships, sexuality, spirituality, substance abuse, laser and electrolysis hair removal, legal issues in identity management, advocacy and participating in the legislative process. There are many more topics too. If you are a female to male transperson, there are plenty of topics for you too!

Just as importantly there is time for FUN!! Usually there will be organized activities and excursions to see local points of interest, to shop, and get pampered in salons.



The conferences provide special attention to first time attendees, so they will not feel frightened. For some, this will be the first time she will have had to be in public and this can be very overwhelming. Some conferences will offer a "big sister or big brother" to help first time attendees. There are sad stories about people coming for their first time who were too afraid to even come out of their room and hid the whole time they were there. Often there are 12 step meetings available for our recovering brothers and sisters.

An illustration of the important role conferences play in some of our lives can be seen frequently on the last night. You will see many people who stay up all night that last night with friends who they wont get to see for another year. Most poignant is watching those who are sad that they will not have an opportunity to express who they truly are for another full year. They look so forlorn, it is heartbreaking. That is exactly how important these conferences are.

If for no other reason, this is an opportunity to learn more about yourself and sometimes you will learn a little bit about other people, different from yourself, but in some ways the same.

I hope to see those of you who I have met and meet many of you I have only met through the Internet this year!

Do the Gender Police Confront You?

Sheri Berenbaum led a thought-provoking discussion about the often-debated topic of gender differences. An inquisitive crowd kept Berenbaum on her toes as she answered questions concerning whether gender differences are innate or learned. Drawing on over 15 years of research on congenital gender disorders—and using props such as Legos and make-up kits to illustrate her points—Berenbaum challenged the audience to "think outside the box" about the mix of social and biological factors that make us male or female. Sheri can be found on the web and also at her University, Penn State.

The Gender Police have drawn hard lines on people of my experience. We have the extreme Right who would say our very existence is an abomination and we have the extreme left who insist that we must identify as some blend of gender that is neither wholly male or wholly female. I find one as constraining as the other.

I wonder where it came from that if we were free and perfectly healthy individuals that if we identify as women, we are not respected as women or if we identify as men, we are not respected as men. This is the problem of the extreme Right. We simply want to live our lives and be left alone to the right of privacy as any other American Citizen.

The other side of the equation exists from the extreme fringes of Feminism and is solely an extension of Womens' Studies professor Janice Raymond's ideology. Even today as she rewrote a foreward to her book The Transsexual Empire: The Making of the SheMale.  Even with her new forward, which is a rather shallow apology to transsexual women, she still sees us as victims of a patriarchy. She was unable to and continues to fail to recognize that we are woman who for many different reasons ended up at odds with our assigned gender. The majority of these do not involve obvious anatomical variations. For this reason being politically coerced into a continuum known as "Gender Spectrum" includes vastly different presentations because of vastly different etiologies, makes us pawns in a political struggle between Left and Right.

Interestingly, the most negative people about the realities of our lives both as individuals and in varying collectives include the extreme Right and the Extreme Left.

For one group, our very existence on the earth is anathamema. For the other group, our very right to a unified gender identity is sacriledge. I find both extremes both nullifying simultaneously.

At this time in our culture, very few who wish to fall under the umbrella  of transgender identify as gender queer. They have every right to that identity. It's not my identity. I do not consider them to have the same orientation of gender or have much in common with me other than a political desire to be left alone and become the best me I can be.

Similiarly people who feel a mix of their genders but have no burning urge to match their physical being to their identity, may be known as transgenders, crossdressers or by other labels that they define themselves by, have every right to be left alone and become the best people they can be.

Simply put, I am a woman. This is not a sociological statement, nor is it a political statement. It is who I am. There are more women who were correctly assigned at birth and individuals such as myself who were not, but sought to correct that error. I do not identify as a third gender or a fourth or a fifth. I'm just a woman.

This is a dual journey that I travel. I am the gender therapist and the gender patient, I bring my experience, professional and personal to the therapeutic alliance. All therapists do that. It is somewhat more unique for my patients as I am also someone who has been going through a legitimate process per the standards of care established by the World Professional Association of Transgender Health, a body of which I am proud to me a member.

As many of you know, I have been developing a comprehensive health care system for transgender people in the Shenandoah Valley of Virginia. I have been instrumental in initiating the Speech and Language Department of my health care system to offer voice and communication therapy for transsexuals in order to be able to communicate in a gendered manner that is congruent with our identity.

In announcement to a health care online network, this program was rebuked with a harsh and in my opinion, unwarrented attack. The author of this attack who is a faculty member of a large institution of higher learning, stated that she found it highly offensive that such a program would state that the therapy offered would improve the ability to communicate in a more masculine or feminine style, depending on the preference of the patient. She stated that because of this, she would not wish to refer anyone there for voice therapy.

Personal disclaimer: I was involved in the initiative to develop these services, provided a number of training resources and linked them with other Speech and Language therapy professionals who are members of the World Professional Association of Transgender Health in their field who could be of further help in developing the program that we offer. In my opinion, they have developed a quality program that I myself have participated in and am so more than just comfortable in referring my patients who are interested in these types of services.

What I find to be most outrageous of this experience is the lack of forethought in the reckless condemnation of a service that person has no personal knowlege of, just a blind conviction of an ideology leading to  the same type of rigid results that the extreme right can be accused of (and rightfully so at times).

This is why I always say that I have found as much as bigotry, prejudice and hatred on the far right and the far left.

The issue at hand that I object to is that this person made a judgement that this person knows better for you than you do, therefore would not even grant you the opportunity to decide if this service would be helpful to you or not. Considering the philosophical orientation of this person, I find as much patriarchy in the Third Wave Feminist theory as they railed against in the Second Wave of Feminism. Each wants to control you, just to a different end, but neither will be the one of your own determination.

A pity, isn't it? I've seen absolutely no growth since Janice Raymond. 

Practicing What I Preach: My Life With the WPATH SOC

I'm sure that some people must imagine that because I am a therapist that I can scoot around the Standards of Care and get what I want using my professional connections with other professionals who work with trans people, but I don't believe that would be in my best interest for my own health care. So I abide with the Standards of Care in my own life. Would you want to have open heart surgery by a doctor who didn't have a standard of care for that procedure?

I have been an advocate for the Standards of Care long before I became a member of WPATH. I know that some people deeply resent the existence of a standard of care and being required to follow a process. Consider this though; The National Center For Transgender Equality (Transequality.org)  and The National Gay and Lesbian Task Force commissioned a survey that reported a number of terribly sad statistics of what many of us have experienced, some things I have personally experienced over the years. 41% of trans people who were surveyed had attempted suicide at least once as opposed to the general public whose rate of attempted suicide is only 1.6%. For those of us who are unemployed, lost a job due to discrimination, or have been forced into sex work, the rates are much higher and for people of color the attempted suicide is 49%. I find these rates appalling and unacceptable.

Addiction and substance abuse are also terrible problems for us. 70% of the survey reported current problems with substances overall. 3% have been denied access to substance abuse treatment programs and 4% have experienced mistreatment while participating in substance abuse treatment programs. As a professional who also has spent a significant part of my practice in substance abuse treatment, I recognize that it can be absolutely crucial to catch a person at the moment they are willing to get into treatment or that moment will be lost and not come around for quite a long time, if ever. If you miss that opportunity, it could literally be fatal. 25% experienced either denial of care or being treated poorly by doctors' offices or hospitals and 16% were denied help or were mistreated in emergency rooms. 12% reported denial of help or were mistreated in mental health clinics. Simply unacceptable.

Another reason to seek out healthcare professionals who use the framework of the Standards of Care is because of the discrimination we face from healthcare professionals which bothers me quite a bit both personally and especially as a health care professional.  Professionals who use the standards to guide practice will likely have a network of local health care providers who can be sure that you have equal access and are treated with the dignity any person is due.

Half of us report we have had to educate health care professionals on our needs and how to treat us. Fortunately, there is a national effort directed by the National Institutes of care to educate the health care community to provide us with competent care. Having WPATH's Standard of Care, provides health care professionals a quick way to get up to speed on how to work with trans people.

One of the pitfalls that some health care professionals fall into is solely relying on the standards and not tailoring them to the needs of the individual. The SOC clearly state that they are not to be rigidly used and state they are a guide to practice. They were not meant to be followed by rote with each patient. Often in the beginning of the learning curve, a professional will tend to rely on them more often ver batim, but as experience is gained the professional often feels more comfortable in relying on their own clinical judgement. I think that I would prefer a practioner who followed them as written rather than practicing in ignorance and possibly making a serious mistake in my own care.

SO all in all, I think having the WPATH SOC benefits us and that is why I use them personally and professionally.

Hello, I'm Sherri Lynne

Hi! I'm Sherri Lynne. I'm a psychotherapist and I am a transsexual. I am a Clinical Social Worker and hold the Diplomate, the highest credential in my field. Although I do many other kinds of therapy, I am a gender specialist, scholar and educator. I am engaged in one of the largest gender programs in Virginia which I created. I've developed a comprehensive program that includes my services as a psychotherapist, a psychiatrist who writes my second opinion letters, aesthetic dermatology, primary care, hormonal reassignment specialists and in January we will be offering voice therapy. All but the services I have offered and HRT (Hormonal Reassignment Therapy) have been initiated in the last two years, so my program is extremely dynamic and represents the state of the art of transgender care. I maintain relationships with a number of surgeons who perform surgical gender reassignment around the country and in Canada.

Over the past three years I have been giving workshops all over the eastern U.S. at transgender conferences and at Universities, some for continuing education credits for mental health professionals. Recently I founded a consulting business, E.I.T.C. (Excellence in Transgender Care), whose mission is to help build comprehensive health care systems that will provide competent and compassionate care. E.I.T.C. also is involved in providing professional education opportunities. I am a member of the World Professional Association of Transgender Health.

I do stay busy! I am also writing a professional text from the perspective of a transgender person who is also a psychotherapist. My goal is to write a book that is accessible to the general public but is informative for mental health professionals as well as practical. I hope it will also lend insights to professionals on what it is like to live at odds in the mind-body continuum and how to apply the WPATH standards of care in the spirit to which they are intended, not as a rigid set of rules that must be followed by rote, as explicitly stated in the SOC.

So, I hope that you will find my blog interesting, informative and thought provoking. I look forward to getting to know my readers and learn from you all as well!

Sherri Lynne