There is theory. And then there is life. Usually these are in some way related, after all that's the idea behind theory. In transgender-treatment they are not. To illustrate this I would like to add two excerpts from A Matter Of Life, the first one is a transcript of a memorable counselling session, the second one is a personal reflection of the official process 


It was summer in mid-town, the heat outside was unbearable but they had air-conditioning at mental-health. I was 10 minutes early, traffic was at times unpredictable in the big city but that day it was light and I didn’t want to stay outside in the sweltering heat. So I got in, passed the armed police-guard (a friendly “good afternoon ma’am!”), the receptionist (“I have an appointment with…”, “yes, dear, go right up”), the elevator, then a hallway where I collapsed into the nearest chair. Waiting.
I suppose I was listening to my preferred radio-station when, right on time, my counsellor showed up. “How are you, you look really happy?”. “I am, very much so! And how are you?”. “I’m fine, thank you!” she said, but made an impression rather like I expected somebody to look after she had just learned that her surgery would be cancelled for no good reason. “…Come in and have a seat…”.
“So, is there anything you’d like to talk to me today?”. “Well… Honestly… Not really…”. “All right, come back in 4 weeks!”.
On my way out I passed the receptionist again (“bye dear…”), then the officer, he was holding the door for me (“bye ma’am…”).
I had an hour left on the parking-meter - what a waste of time!


Except for a few decades of useless delay, a potentially unnecessary drug-addiction, a year’s life on absurd levels of carcinogens, a body deformed by a puberty and life on testosterone, a medication-induced suicidality which luckily I survived without an attempt, having been denied emergency medical service, being stigmatized mentally ill and missing-out on half a lifetime I can’t say that I have been treated badly by that system for having needed that gender-alignment...
But then I did keep away for 30 years, didn’t I? I was in mental-health less than 11 months, some 20 sessions in all with two different psychologists, some sessions lasting less than 5 minutes. I was sent there because it is “the agreed upon way to do things”, or at least the maximum they were willing to ‘compromise’ on that “agreed upon way”. Because they thought they needed these signatures. Because they were told that they do absolutely need these. No matter how much they had to abuse me to get these. And because they believed this and complied!
Both psychologists as well as the medical people agreed that it was a painful and expensive waste of time and I suppose quite a few people sighed relief when I was gone. Though maybe not all for the same reasons…
Sometimes I got the distinct impression that abusing me was not all that easy for some of them because I was honest. I felt mistreated and I said so. I felt I was wasting my time and the time of other people and I made that clear as well. But they had their “professional standards” and these required them to put a certain minimum time and effort into abusing me before they thought to be in a position to declare themselves “compliant to doctrine” - and therefore entitled to sign the paperwork. Or ignore it. Like that half million or so cases before me. Nobody ever admitted that what they were doing was wrong, but nobody ever dared to suggest that it was right either. But however friendly it was done, in the end it was abuse nevertheless.
Of course publicly what matters is not what happened to me behind these closed doors. Not the pain I now have to deal with because I sought treatment and found institutionalized abuse instead, intermixed with a few people who didn’t feel too good to hand it out. What matters publicly is that this is seen as right! That I have been branded a transsexual visibly, not just rhetorically but openly published in government records and of course this stays, even now when I’m no longer transsexual. What matters is that by some people, including sadly enough a good majority of medical doctors, I am seen as a person who is incapable to live independently or at best lives somewhere on the fringe of human society. A person who will be dependent on psychiatric support for life, somebody who’s been medically declared mentally incapacitated, a person whose mental processes are deranged to a degree which warrants government sanctioned forced intervention, a person who can’t be trusted to make sound decisions that match “common sense”, not for herself never mind for others!
I am none of the above but people who duly appoint themselves to know better rather efficiently spread that idea. It doesn’t help if they declare that what they do to us should not be seen as stigmatization and it should not be seen as if I were incapable to make decisions (this is stated explicitly in dogma) when at the same time they go out and suspend my civil rights, severely limit my rights of making decisions about my healthcare and my own body, force their services onto me against my explicit wishes and get government-approval (and backing) for doing this! It doesn’t help if they say that I’m not crazy when at the same time they officially state that my treatment, genital alignment, is solely accepted as a last resort treatment for the most severe otherwise incurable mental cases! What counts to me as well as to the public is not what they claim they don’t intend, what counts is what they actually do! Nobody is going to read (or believe) what they presumably didn’t intend anyway!
Of course the solution would be very, very simple: If it were true that they would not deem me mental then they should not just “officially state this”, but act on their own enlightened statement! They don’t - which proves more than any verbal declaration ever could that their statement is not to be taken seriously! It doesn’t take much to understand this, in the real world everybody seems to get this just fine! If expert psychiatrists still say that this isn’t what they do then they are in complete denial of reality. Maybe not theirs but certainly everybody elses!
I suppose I could have gotten away with far less compliance to dogma. I was offered genital surgery to take place less than 8 months after my first visit with my treating family-physician, after less than half a year of mental-health and only 4 months on HRT. I declined because I could not provide proof of these dogmatic requirements, even though nobody ever asked for any. I had my surgery 367 days after commencement of medical treatment, the minimum requirement set by dogma being one year. (I suppose if it’s a leap-year it takes people a day longer to “get ready”, but then again, it’s all mental anyway. Sorry. It’s all mental-health, so I stopped trying to make sense of it and to understand what the reasoning behind things could possibly be because there isn’t any. Just do as told!).
I have yet to see a psychiatrist and as I do not have any mental problems I couldn’t easily solve myself why would I want to? I’m now just a woman, legally and otherwise, and I agree very well with it!
My “detailed psychiatric letter of recommendation bearing two signatures”? It is a one-page document, 14 lines of text, written by a psychologist from our local gay & lesbian community-counselling service. This is very much a personal treat as the dogmatic psychiatric institution in town who does trans, most cases in fact, one of these places where one takes many years just to be accepted as a transsexual, also puts-out one page letters these days - although they’re mostly all the same, cut & paste using a word-processor. Theirs say that the person is mental and not otherwise treatable but “is stable”, “has fulfilled ‘their’ criteria of the Real-Life Experience” (or in layman’s terms: “complied to absurdly painful, excessive and abusive behavioural and physical modification and is damaged severely enough she’s now deemed incapable to raise objection of any sort”) and that the individual “presents as well prepared for surgery” (whatever they mean by this, but I am certain they think they know). They end their letters with the phrase “I trust this is helpful to you” and two signatures, M.D. psychiatrists, as required. Mine says that I’m an ordinary woman with an extraordinary life. It ends with “good luck and all the best wishes for your future!”.
In the end nobody really cared about dogma, standards or mental treatment. But everybody still needed their behinds covered!
This is about dogma, about dogmatists, it is about homophobia and about having to submit to certain people’s expectation as to what a human being or more specifically a woman is. How we have to think. How we have to feel. But mostly how we have to look and behave!
This is not about me, about my healthcare, about my life. It is not about us, it never was. This is all and exclusively about them! It is not about my emotional life but about protecting their stereotypes! It is not about who I am, it is about who they say I must be!


Yes, I understand. I am one of the first who has ever been allowed to get the entire treatment (legally) without ever having seen a psychiatrist for it. I still see my GP for general healthcare issues (if these arise) and for trans-prescriptions about once a year (which I feel does nothing else than getting in the way of our relationship and my view and experience of medicine in general).
I am thankful that this was possible this way as I think that I would not have survived "the approved upon way of doing things". I would have perished in the process, somehow, most likely by suicide. As so many, many others have. Because in the end what we need is the freedom to express ourselves: Emotionally, socially, but in our case also hormonally and physically.


We do not need an illness managed, we do not need our deaths prevented. What we need is our lives given back to us!

 What we need for life is to live ourselves, not to be told who we have to be!