This exchange occurred some years back, before I had transitioned.

thirtysomething writes:

> The RLT *is not* a "test" given for the purpose of diagnosing transsexuality.

> Sex Reassignment is a *treatment* for the condition, and the RLT -- more often called transition -- is a period of learning and adjustment to a new social role. During this time, some find that this *treatment* is not for them -- for many reasons, including but not limited to a better understanding of who they are. Many people with a well-formed gender identity that is at odds with their sex assignment at birth NEVER transition.

> And sex reassignment is not the only treatment for transsexuality. Other concurrent and/or alternative treatments have helped people with this |> terrible condition to function in society, with some measure of comfort.

Please don't read so much into what I said. From the viewpoint of the mental health community, TS is largely a self-diagnosed condition. RLT is just about the only proof of that diagnosis. And, since RLT is required before SRS, then yes, it is a test (Real Life Test, or RLT), and any therapist who recommends SRS for someone who has not successfully completed a one-year RLT needs to be ready to defend his or her recommendation.

But let's back up a minute...........

RLT is NOT the same as living full-time in the gender role of one's choice. I will be going full-time in a couple of months, because that is what I want to do with my life. I am not doing it to prove that I'm a woman inside--I already know that, and I don't feel any need to prove that to anyone else. I am not doing it as a pre-requisite to surgery, because I may decide not to have SRS.

I certainly would never say that SRS is the only treatment for transsexualism, given that I may not have SRS myself.

I also know people who have stopped transition and gone back to their original gender role. I know why they did it, and I respect their reasons. I know people who are unable to transition, and I know the hell they are going through because of it. In each of these cases, I know what they are doing to cope as best they can, and I respect them for that. Yes, there are alternatives to transition and to SRS; I never suggested otherwise. At the same time, those alternatives may be viewed as second- or third-choice; for each person, the choices and the cost of those choices are different. I recognize that.

Neither hormones, transition, nor SRS are sufficient treatments to enable people to be happy with their gender identity and gender role. They MAY be a PART of that treatment, or they may not. The real keys to happiness include self-acceptance, self-respect, and self-appreciation. It is important for many people to feel that they have enough control over their own lives to make their own choices, but not everyone has that luxury. Not everyone can afford the cost of the choice they would prefer, and not everyone who can afford those costs is willing to pay them. And when I speak of costs, I do mean everything: not just financial, but life options, jobs, the risk of rejections, family losses.... everything that we may have to give up to be the person that we want to be. I would NEVER put anyone down for their choices, and I will ALWAYS wish people well for the choices they make. I am not the person who must bear the cost of their choices, and I certainly cannot know whether the benefits of their choices are worth the costs that they pay, willingly or unwillingly.

In late 1997, my views had evolved and expanded somewhat...

The whole business of RLT is something that bugs me. Some people look at this as two routes, with the choice being (simplified) living as a transsexual and living as a woman. It's rarely that simple; one local TS came here from another state, changed jobs in the process, and was outed to her new boss within a week by a client or sales rep whose territory covered both states. Hiding from your past is hard. (Her boss was a CD who knew the whole story; no damage was done.)

But I see the "transsexual versus woman" as a false choice. This is my opinion only, not a flame, and I don't want to start another war--we've had too many lately. I also hate the term RLT; same caveats.

I had a wholly different view of transition, and it has worked well for me.

For background, I'm also an abuse survivor. Those were the issues that I had to deal with first; those were the issues that were about to kill me. I came out of that round of therapy as a very changed person. I liked who I was. I was happy to be alive. I was at peace for the first time in my life. Except for this one, small detail.

So I started working towards transition. I took my time. This was not something I wanted to rush through, or could rush through; I needed a lot of time for electrolysis and hormones to work before I could be ready. Then I transitioned; as with others, the only real choice I had was transition in place. That was fine with me. I'd suffered enough losses in my life, and my first decision (after deciding to transition) was that I would minimize the losses that would occur.

Within a couple of days after transition, I came to one very big realization. I didn't need surgery. Simply by transitioning, I had gotten everything that I needed out of these changes. Surgery became a choice, something that I could look at more objectively in relation to the other issues in my life. Since surgery was an issue with Carol, I was able to accommodate her--because I had first made my own decision about what was a need and what was a "wibni." ("Wouldn't it be nice if...")

The week of transition, I told my therapist that I wasn't going for surgery. After she took a couple of minutes to be able start talking again, we finished the session. The next session, we agreed that we'd been through everything else, and that there really wasn't any need to continue therapy except on an as-needed basis.

Two weeks into transition, and I was off the treadmill. I was no longer living to meet anyone else's standards. No one was watching over me. I was living my transition for me and for no one else. It was incredibly freeing.

It's also the way it should be, as far as I'm concerned. Transition is hard enough, without feeling that we "have to do it right" or that we have to live up to someone else's standards. (Almost invariably, someone else who hasn't lived this life.) Transition is something I did for me. It's not about living as a transsexual or living as a woman, although I happen to be both. It's about the freedom to be the person that I need to be.

This is why I hate the term RLT. "Real life experience" is no better. Both of these are really outsider terms; they are there because a "successful" transition (who are they to judge?) is a prerequisite for surgery.

I've had a successful transition. I fit into my new gender role. I've kept my job, my relationship, my professional associations, my church, and nearly all of my friends. I pass; I usually even pass on the phone. I don't out myself except as needed, when I have to connect with my past; on the other hand, I always assume that people know, and I don't try to hide anything.

The changes brought about through transition have improved my life. I'm happy with the results. Why should this be a test? I'm the only person that this really matters to. Yes, it does matter a lot to Carol, but in order to make it through transition with me she first had to love me as a person. The truth is that she likes me better as a woman than as a man; I can live with that.

The question is, what does any of this have to do with surgery? (Outside of my relationship, which isn't a RLT requirement in any case.) If one can live successfully as a woman without surgery, then what does passing the "test" have to do with being qualified for surgery? It's worse than unrelated; it proves you can live without surgery.

Let's draw an analogy with the past for a minute. Once upon a time, not so long ago, you could only get surgery if you wanted a man. A successful RLT wasn't enough. Now you have to prove you can live as a woman without having surgery; this amounts to "proving that you don't need surgery" in order to get surgery. That's still absurd. I would hope that no gatekeeper would turn anyone down for surgery because of a successful RLT, but this is something that's really open to interpretation. What is the role of the reccommending therapist? To agree that one will benefit from surgery? To decide whether one needs surgery?

More and more, I'm coming around to the position of the SOC that was proposed by the ICTLEP (I'd suggest reading it.) Bringing it down to plain English, it says that if you want it, you can have it. To be more precise,

1. You want it.
2. You can demonstrate that you know what you're getting into.
3. You are willing to assume legal responsibility for your decision.
4. It will not aggravate existing health problems.
5. For surgery, you must convince the surgeon that you've been on hormones for one year. (In most cases, I'd assume that a pair of breasts constitutes proof for MTFs; voice and facial hair would be proof for FTMs.)

That's it. That's all of it, outside of the usual ethical and reporting requirements placed on caregivers. Items 1 through 4 apply for hormones, so there's no extraneous gatekeeping going on there, either.

None of this is to devalue therapy or other support mechanisms. There will continue to be questions about when the appropriate time for surgery might be (see Gianna Israel's article on post-op living) but this is very much an individual question; a fixed "one year test" may be too long for some and too short for others.... With the caveat that it should not be a test in the first place. It's an individual decision, a personal decision, to be made in the whole context of one's own life and needs.

What I don't see is a role for outside evaluation. It should be sufficient for a therapist to sign off that we fully understand the issues and the risks related to genital surgery.

What it's about is giving us back control over our lives, and about treating us as adults.