The Gatekeeper Process and the Issues That Come From It

There are two posts today. Read the other here.

So lately, I’ve been trying to get the local Veterans Affairs (VA) hospital to start covering the costs of my transition like they’re supposed to, and running into a lot of issues. Basically, I’ve been forced to go through the gatekeeper process again. For those who don’t know what that means, the gatekeeper process is the series of doctors, therapists, lawyers, and approvals we have to go through in order to transition. It’s so named because it’s essentially a series of gates we strive to go through, and before each gate is someone blocking the way, determining if we can go further.

See, the way it works is this. Before we can start hormone therapy, we need to see a therapist in order to get a letter certifying us as trans. The we have to go see a doctor, who will determine if hormones are right for us, which ones to use, and what dosage. Then when it comes time for us to get surgery (any of our surgeries), we have to go and get another letter from a therapist, and sometimes two letters from different therapists, before we can even set up an appointment with a surgeon. Two weeks before surgery, any surgery, we have to stop taking hormones, and stay off of them until whatever time the doctor says is ok.

Let me put this into perspective for you. For a cis woman to go in and get a nose job because she doesn’t think her nose looks cute or feminine enough, the only question asked is “do you have enough money?” When a trans woman wants to go in and get that same surgery, she needs a letter from a psychologist or psychiatrist stating that she’s sane and knows what she’s doing and has to go off of her hormones for a minimum of two weeks, and more likely three or four (thus causing her to have to deal with more testosterone if she hasn’t had the appropriate bottom surgeries yet). If at any time one of the various gatekeepers decides not to let us continue, we are effectively blocked from going further in the physical aspects of our transition.

Theoretically, this is to make sure we go about this carefully, are certain it’s what we want to do, and that there won’t be any regrets. In practice, however, it has traditionally enforced societal stereotypes, denying transition to all but those who can realistically pass (I normally hate that word, but it applies here) as feminine, attractive, heterosexual women. The guys didn’t even really have much of a choice back then, they were the “stone butches” and unable to transition. Sadly, this still continues somewhat today, with only those who are hyper-feminine or hyper-masculine (or pretend to be for the psychiatrists) able to begin the process. It literally used to be that you couldn’t even start hormones unless you were already living full time (not an easy feat for someone without hormones), and many therapists today won’t give that letter unless someone presents in an “appropriate” manner when they come visit.

Another problem with the system is that often, the specialists aren’t available, or we get referred to someone who isn’t a specialist, and thus we have to educate our own gatekeepers. This happened yesterday with me and the VA psychiatrist. The local VA does have someone in their mental health department who has experience dealing with trans people, but I was not referred to her. I was referred to a PTSD specialist specifically because he did my post-deployment screening to make sure I don’t have serious PTSD (I have PTSD but not serious enough for them to worry). He admitted in the interview that he had no clue what he was doing with this topic, and instead asked me more about things like if I find myself having a hard time partaking in leisure activities, or about my sexual orientation. When something like this happens, it means we don’t get the care we need and are often stuck at the gate just as surely as if the gatekeeper was deliberately denying us access.

People need to learn that transsexuality is not just being gay taken up to 11 (a misconception that still continues to this day, hence the VA psychiatrist asking more about sexual orientation than gender identity). Sexual orientation is who you want to go to bed with. Gender identity is who you want to go to bed as. And gender presentation is… I dunno, what style pajamas you wear. Still working on fitting that into the adage. Commonly quoted saying aside, the gatekeeper process is often more problematic than helpful, and anyone who has to go through it multiple times at any step (or all of them) is going to have serious issues with it.

Has anyone here had similar experiences dealing with gatekeepers? Or are there any questions on the topic?

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One response to “The Gatekeeper Process and the Issues That Come From It

  1. Pingback: The Skinny on Asexuality | Transendent Lives

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