This is a non appologetic commentary. I think transsexuals generally get poor treatment. I think just because a doctor treats a transsexual does not mean that he or she is doing the transsexual a big favor. I think that many doctors who are treating lots of transsexuals are doing a bad job. I think the medical community has a lot to learn about treating transsexuals.
I think I have a lot of insight to offer on how transsexuals should be treated by doctors.
Obtaining Treatment
Transsexuals find it very difficult to obtain adequate medical care. Individual practicioners should go out of their way to provide care for transsexuals. Any practitioner who turns a transsexual away, or denies him or her a particular kind of treatment, should realize that in all likelyhood the transsexual will not be able to obtain this care elsewhere.
are experienced in providing inadequate treatment. Doctors should be willing to treat transsexuals even if they have no prior experience. A little research and some common sense is all that's needed to treat a transsexual.
Prescribing Hormones
Doctors often have tunnel vision regarding treatment of transsexuals (in There are no experts on treating transsexuals. Many doctors with experience particular with regards to hormones). If they've treated one transsexual, they often want to treat all other transsexuals the same way. This is not acceptable because there are no accepted standards in treatment. Though many people seem to feel that one form of treatment is "the best" there is no concensus. Doctors should be willing to administer any reasonable hormone regime to a transsexual patient.
Many non-transsexuals advocate extreme caution in administering hormones because it can cause permanent changes to the body. The error in this line of thought is the assumption that the body without hormones is not changing. For example, testosterone in the male to female transsexual will constantly masculanize her body at any age, in particular during the years prior to age 25. This is a state of change that is very undesirable to the transsexual patient, and can be best characterized as a progressive disease that requires treatment. Doctors that are not comfortable perscribing estrogen to an M2F patient should consider then perscribing anti-androgens (i.e. Spironolactone).
The Standards of Care provide guidelines for, amongst other things, the administration of hormones. Non transsexuals (and some transsexuals) often regard the Standards of Care as providing reasonable requirements prior to the administration of hormones. I encourage transsexuals who find the Standards of Care reasonable to abide by them. Many transsexuals, myself included, did not find the standards of care reasonable. Most transsexuals who do not find the SOC reasonable, myself included, obtain hormones through unsafe channels. It must be emphesized that a transsexual who chooses to not follow the SOC is not being irrational, or refusing to play by the rules because he or she is stubborn. Many transsexuals find the SOC to be unaceptable for legitimate reasons.
Legitimate objections to the SOC include financial limitations in obtaining a therepist, practical limitations in obtaning a transsexual-positive therepist, and the belief that it is inappropriate for another person to direct what a transsexual may and may not do with his or her own body. Ultimately any adult who seems capable of rational decision making, who understands what hormones will do to their body, should be allowed to choose to take hormones. Hormones change the body slowly over time, there is ample opportunity to stop taking hormones. Therepists have a legitimate role in helping transsexuals and non transsexuals make decisions about their life and their bodies. Therepists should not have the power to decide what treatment transsexuals can and can not receive.
Prior to prescribing hormones, doctors should discuss reproductive options with transsexuals. This includes for the male to female, freezing sperm, and for the female to male, freezing eggs. Since hormones impact fertility, and SRS ultimately makes transsexuals infertile, it is important that transsexuals have a chance to choose to make use of medical reproductive options.
Transsexual Youth
Youth transsexuals deserve special attention and consideration by doctors. When a youth expresses that he or she is transsexual, people are more likely to dismiss or trivialize that expressed desire. When a youth expresses they are transsexual they probably are--transsexuality is not a phase people grow out of. Doctors should let youth know that they support them in making decisions about their own bodies, and that they believe youths when they express that they are transsexual.
Youths often don't have the financial resources of older transsexuals. They also often must hide their transsexuality from their parents. Accordingly it can be much more difficult for a youth to obtain a therepist. Many therepists are unreasonably cautious about approving hormones for youths.
Youths tend to be more demanding that treatment begin immediately. Youths often perceive their bodies as being in a state of extreme, unwanted, change, and they are correct! It is not unreasonable for a transsexual youth to request, and receive, immediate treatment. It's not unreasonable for a non-youth to request it as well, a youth is simply more likely to do so. It is insensitive to deal with a youth with the perspective that 3-6 months isn't that long to wait.
Youth are entitled to treatment without the support or knowledge of our parents. If we are of the legal age to make autonomys medical decisions, we should be allowed to do so. If we aren't, then our doctors should help us obtain a mediator who can communicate with our parents. That mediator should be a person who believes that an underage youth should be allowed to undergo HRT. Many people do not believe underage youths should ever be allowed to go on HRT. This is unreasonable and cruel. Studies have shown that youth tend to transition and adjust easier than older people.
If Estrogen/Testosterone is not possible for a youth who expresses a desire for HRT, then the possibility of suppressing additional masculanization/ feminization should be explored. Anti-androgens such as Spironolactone can allow a youth to reduce unwanted affects of puberty.
Surgery
Not all transsexuals want surgery. Some transsexuals want surgery, but decide at a later date that they do not want surgery. There are many legitimate reasons for a transsexual to not want surgery, but still want to change their gender socially and undergo hormone therepy. It is unreasonable to demand that a patient express they want genital surgery as a precursor to perscribing hormones. Doing so simply results in the transsexual lying to you. Similarly demanding a patient express a particular sexual orientation is inappropriate.
Orchiectomies
Many M2F transsexuals have orchiectomies because SRS is unobtainable for them at the time, or because they believe an orchiectomy would better suit their needs. If a patient expresses a desire for an orchiectomy you should try and refer them to a surgeon who would be willing to perform that procedure. If a patient expresses a desire for surgery, and frustration with difficulty in obtaining it, an orchiectomy should be presented as an option.
General Medical Treatment
Doctors should do their best to appear comfortable and be comfortable in examining transsexual's bodies. I've know doctors who wouldn't do general physicals for transsexuals. There is nothing wrong with transsexual bodies.
Transsexuals may not be comfortable with certain kinds of medical exams. For example, prostate exams in a male to female (I'm very uncomfortable with those). Alternatives should be discussed with the patient, and presented. If a transsexual appears uncomfortable they should always be told that the test does not have to progress. As a non transsexual, doctors can not understand how transsexuals feel about these things, and should not trivialize our concerns.