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| HBIGDA STANDARDS OF CARE - 2001 (version 6) |
SECTIONS |
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IX. The
Real-life Experience
The act
of fully adopting a new or evolving gender role or gender presentation
in everyday life is known as the real-life experience. The real-life
experience is essential to the transition to the gender role that is
congruent with the patient’s gender identity. Since changing one's
gender presentation has immediate profound personal and social
consequences, the decision to do so should be preceded by an awareness
of what the familial, vocational, interpersonal, educational, economic,
and legal consequences are likely to be. Professionals have a
responsibility to discuss these predictable consequences with their
patients. Change of gender role and presentation can be a factor in
employment discrimination, divorce, marital problems, and the
restriction or loss of visitation rights with children. These represent
external reality issues that must be confronted for success in the new
gender presentation. These consequences may be quite different from what
the patient imagined prior to undertaking the real-life experiences.
However, not all changes are negative.
Parameters
of the Real-life Experience. When clinicians
assess the quality of a person's real-life experience in the desired
gender, the following abilities are reviewed:
- To
maintain full or part-time employment;
- To
function as a student;
- To
function in community-based volunteer activity;
- To
undertake some combination of items 1-3;
- To
acquire a (legal) gender-identity-appropriate first name;
- To
provide documentation that persons other than the therapist know that
the patient functions in the desired gender role.
Real-life
Experience versus Real-life Test. Although
professionals may recommend living in the desired gender, the decision
as to when and how to begin the real-life experience remains the
person's responsibility. Some begin the real-life experience and decide
that this often imagined life direction is not in their best interest.
Professionals sometimes construe the real-life experience as the
real-life test of the ultimate diagnosis. If patients prosper in the
preferred gender, they are confirmed as "transsexual," but if
they decided against continuing, they "must not have been."
This reasoning is a confusion of the forces that enable successful
adaptation with the presence of a gender identity disorder. The
real-life experience tests the person's resolve, the capacity to
function in the preferred gender, and the adequacy of social, economic,
and psychological supports. It assists both the patient and the mental
health professional in their judgments about how to proceed. Diagnosis,
although always open for reconsideration, precedes a recommendation for
patients to embark on the real-life experience. When the patient is
successful in the real-life experience, both the mental health
professional and the patient gain confidence about undertaking further
steps.
Removal
of Beard and other Unwanted Hair for the Male to Female Patient. Beard density is
not significantly slowed by cross-sex hormone administration. Facial
hair removal via electrolysis is a generally safe, time-consuming
process that often facilitates the real-life experience for biologic
males. Side effects include discomfort during and immediately after the
procedure and less frequently hypo- or hyper-pigmentation, scarring, and
folliculitis. Formal medical approval for hair removal is not necessary;
electrolysis may be begun whenever the patient deems it prudent. It is
usually recommended prior to commencing the real-life experience,
because the beard must grow out to visible lengths to be removed. Many
patients will require two years of regular treatments to effectively
eradicate their facial hair. Hair removal by laser is a new alternative
approach, but experience with it is limited.
| Some
of the resources in this section contain differing viewpoints comprising
a variety of authors, committees, and interest groups. Additionally,
some of these materials are delivered in an advisory context, covering
legal, ethical, medical and social issues. These materials do not
necessarily represent the guidelines of TransGenderCare or
the philosophies of our staff. |
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