I had a most wonderful visit with a new provider—A psych provider. She is a psychiatric nurse practitioner. The reason why I am seeing her is specifically to get a letter of recommendation from a competent mental health provider for vaginoplasty surgery. WPATH’s Standard of Care (SOC) recommendations for this surgery includes two letters from qualified mental health professionals along with being on cross hormone treatment for 12 months. Oddly enough, I remember no requirement at John Hopkins for living as a woman for 12 months, but I will have that down in January and the hormone treatment in April.
Originally, I planned on having my psychiatrist provide the second letter. However, I lacked confidence in her ability to assess me properly or having the necessary qualifications for the letter to be accepted. She had been responsible for medication management for my bipolar condition (thankfully in remission). She had never treated another transgender person, or new about how to diagnose gender dysphoria, an unfortunate designation, implying that a person with these kinds of issues is mentally ill, as it is a diagnosis in the DMV-5. But, I digress.
The new provider has treated around ten transgender patient and knows about gender dysphoria and its diagnosis. She too has issues with the term or seeing it as a mental disorder. She doesn’t even care for the newer and less stigmatized gender incongruence. It is unfortunate that WPATH’s SOC still medicalizes this aspect of transgender treatment. The surgery is certainly medical but the path to it does not necessarily have to be so. Again, I digress.
She was immediately able to put me at ease when we first talked on the phone, and I was impressed by her prompt responses to my messages on the patient portal for the practice. My first visit was via a Zoom connection, but again immediately I felt a good connection had been made (not the Zoom connection). Okay, I rely a lot on my intuition when I am dealing with my trans issues, as well as other areas of my life when dealing with others. This does not mean I do not cognitively assess the situation, but I have never once been disappointed with my intuition in these cases. The appointment was for an hour but in ran 45 minutes over. I also found out that she set up her current practice to be welcoming to LGBTQ clients.
Not only did I feel she was competent to produce an acceptable recommendation letter, I felt her competency in following me for my bipolar condition. We talked about many of the significant mental health issues I have faced, which currently do not affect me in a present way. Yes, they make up part of my path in life, but I now can claim that I feel mentally well. So, we are going to work together to get the necessary letter produced as well as make sure that if I became symptomatic as far as the bipolar or my previous anxiety should return it can be treated. This seems extremely unlikely to me at the moment, but you can never rule it out.
I will be meeting with her once a week for an hour. I feel this should be sufficient time to have an acceptable letter by April, which is the earliest possible date I could possibly have the surgery. Other things are involved other than meeting the WPATH’s SOC. But, I am confident that I will eventually be fully prepared both mentally and physically.