Why I Am Not A Cheerleader For Informed Consent

Something that's been buzzing around my head since I learned about it a few years ago is the idea of "informed consent."  This is a model of getting hormones (and other related medical care) in which rather than going to therapy for a certain amount of time to make sure hormones are what the client needs, clients sign waivers stating that they are aware of the consequences of hormones, what they can and can't do, and that they are of a sound mind to make such a decision.

It's not that I think informed consent is a bad thing--on the contrary, I tried very hard to find somebody who would give me T without a letter before I buckled down and went to a therapist--it's that the discourse surrounding it is based on what I would call "friendly myths" about trans people.

So there are a lot of reasons I really don't promote informed consent.  Admittedly, it is bent toward American trans men, although this whole blog is:

1. It's brought up a lot to people who have not been out for a very long time at all.This is based on that "friendly myth" that if people say they are trans, they are.  That doesn't mean you shouldn't treat them as if they aren't or even as if they might not be, just keep in mind that not everybody you meet on the Internet or in a support group is actually trans.  I know there are going to be people boiling in their boots when I say this, but there are people who decide they want to transition because it's the "in" thing to do or because they have unresolved internalized homophobia.
   Those people will usually dissolve that desire to have hormones once they try living as male for a while and realize it's just not them.  That's fine, but if they've already jumped the gun and started using hormones to masculinize themselves, this is a big problem for both them and the community.  The rate of detransition for trans people who have gotten medical care is rather low.  It's pivotal that we keep it that way, because that's a rough process to have to go through.
2. The low level of contact encourages people to lie.
   The above of course can be easily solved by just saying "You aren't eligible for informed consent unless you've lived in-role for a set period of time," right?  In fact, the standards of care even state that you shouldn't need therapy if you have already been living as male for a long period of time.  Where's the problem?
   There isn't one... if people are telling the truth.  The entire reason I'm thinking about this today is because a guy was cheerleading for informed consent while outright admitting that he'd gone into the doctor's office, played a role, and lied about how long he had been out.  Informed consent, which is usually only available to people who have been out for quite a while, encourages this kind of behavior.
   Therapy can encourage lying, too, but therapists are trained to spot that sort of thing.  Plus, if you have three months of therapy you know that you've been dealing with this at least that three months.
   
3. Therapy gives you more benefits than most people think it does.
   Admittedly?  In some ways this is a regional thing.  Here in Wisconsin a therapist can give you a letter that will get your driver's license changed to male (and your lived name if that hasn't been changed yet) before you are even given a diagnosis.  A lot of people aren't aware of that, but a good therapist will be.
   And if you haven't come out yet--at work, at school, to family, to friends--or if you haven't been living as male full-time, or if you have hang-ups with restrooms and things like that, a therapist can give you help that an endocrinologist might not be able to.
4. It's not an option that's available to everybody.
   This isn't a cut on informed consent in general.  Again, there are benefits for a lot of people.  You don't have to pay for therapy, there's a better chance you won't wind up being diagnosed with a mental illness, it's faster, it puts power in the hands of trans people, etc.  But it's also not available to everybody.
   The closest place I could find to where I live that did informed consent was two and a half hours away, and because I lived that far away and didn't have good enough insurance they rejected me.  I asked other trans men, I asked my doctor, I asked a lot of people... and I could not find somebody who would do this for me despite having lived as male for six years at the time.
   Can you find them around here?  Probably.  But it's a royal pain in the ass, so many doctors don't want to be known as people who will give hormones to trans people without therapy and keep their activities hushed.  And there are some states that barely have doctors who will do it with therapy let alone without.
5. The problems with therapy can be alleviated by better education regarding transition standards and better access to health care.
   Yeah, informed consent is cheaper, especially for people without health insurance.  But we're talking about a health care need, here.  Why is therapy made into the issue and not the right of trans people for proper health care?  Or all people, for that matter?  It's a similar story to people who hand out those contrived Xeroxed pamphlets to women explaining how to be their own gynecologists by shoving specula into themselves and doing guesswork with a mirror rather than championing the right of women to get that health care from a professional.  It's the wrong fight.
   Yeah, informed consent gets rid of the need for therapy a person might not need.  But if therapists and doctors actually listened to a copy of the HBSOC that isn't ancient, they would know that this isn't a standard anymore anyway.  Again, it's the wrong fight.

Informed consent is a good option for people who have access to it, who have actually been living as male for long enough where they are out of the "honeymoon" period so many of us go through, and/or really can't at this moment in time swing therapy.

But that doesn't mean it needs to be promoted everywhere the subject comes up.  It's not the best thing for everybody.