Fact finding - Diagnostic process at the Gender Clinics

[gardenbird48]

I hope this is allowed and not restricted information or anything? In conversation with a friend, I wondered if anyone knows what the actual process is when you get to the Gender Clinic? Interviews, questionnaires, psychometric tests(??) counselling etc?
At the moment it appears that with the Affirmation only approach, that would seem to imply self diagnosis but there will obviously be more to it than that. I’m trying to work out what.

[Aesopfable]

but there will obviously be more to it than that

I am not so sure. It will be interesting to hear.

[BlackWaveComing]

My kid wasn't diagnosed at a clinic but by a private psychiatrist.

2hr session, incl a short developmental history from me, boom, diagnosed.

Psychiatrist explained to me the diagnosis is 'low-hanging fruit' ie it's an easy one to give out. Kids know what they need to say to get it.

I got the impression that just having the diagnosis was pretty meaningless because it's gameable.

Older child was diagnosed by the by during a hospital admission. It's never been a primary diagnosis, the psychiatrist gave it but dismissed it at the same time (fad, I believe were his words to me) and child has never been given or asked for treatment for it.

I don't believe it exists. Very rarely, a sex-based dysphoria does, but gender dysphoria? Even the independent psychs don't seem to take it very seriously. What use is a diagnosis like that? it seems to just describe 'patient answered these questions in this way'.

I assume in a gender clinic they do take it more seriously.

[gardenbird48]

Psychiatrist explained to me the diagnosis is 'low-hanging fruit' ie it's an easy one to give out. Kids know what they need to say to get it.
Thank you for your response Blackwave - it is helpful. Could I ask if either of your children has been able to access any treatment as a result of their diagnosis or is that something that is then dealt with by the Gender Clinics?

[Smallblanket]

Our experience of adult Gender clinic. Diagnosis of GD and referral on for hormones given after a single 45 min appointment. No therapy offered, no investigation of alternatives, no exploration of autism. Not even any practical advice or therapy to manage mental health while waiting. Second 45 min appointment to look at paperwork (I think that also counted as a "second opinion". ). It's the lack of psychotherapy which really is striking - the clinic is there to facilitate transition, that's all.

[SisterWendyBuckett]

It's the lack of psychotherapy which really is striking - the clinic is there to facilitate transition, that's all.

Mine followed the script - and told me so - in order to get the required hormones from the adult clinic.

Counselling is pretty much meaningless, in terms of getting to the nub of body dysphoria issues, when the young adult will only see someone who follows the 'affirmation' path. Anything else is deemed 'conversion therapy.'

It's an absolute farce and this is no way to help a generation of distressed young people.

[InvisibleDragon]

This open letter to the GIDS director, from a Clinical Psychologist who worked at GIDS is quite informative about the process:
medium.com/@kirstyentwistle/an-open-letter-to-dr-polly-carmichael-from-a-former-gids-clinician-53c541276b8d

[Smallblanket]

It's a scandal

[gardenbird48]

thank you all for your responses so far and for that article to PC.

Is it ok to ask if any of you have any experience of the planned pathway and assessments to consider any next steps to be taken after a period of hormone treatment? Would this be called a care plan?
I'm guessing further psychological evaluations/review of the treatment so far and to assess whether it is surgery that the patient needs or assistance to stop taking the hormone treatment (I know that coming off long term antidepressants is a huge process so while it is a different type of treatment presumably the weaning off hormone treatment for a patient that requires that going forward could be equally big).
Obviously I realise some people go private so it may be slightly different but some people do get it done on the NHS as I understand.

[gardenbird48]

@SisterWendyBuckett @Smallblanket @BlackWaveComing - thank you so much for your input - I am asking the further questions because I'm trying to work out what would usually be sensible with any case that involves medical treatment but worryingly from your responses so far it would seem that I am way off the mark and that effectively children can self-diagnose into major surgery and life changing hormone treatment (which I realise has been gone over before) but it is the apparent self diagnosis element of it that is just hitting home for me - if it this the case then that is just unreal!!
No one is allowed to self-diagnose for any other condition that has medical implications ie. surgery - no one..

[BlackWaveComing]

@gardenbird48

Psychiatrist explained to me the diagnosis is 'low-hanging fruit' ie it's an easy one to give out. Kids know what they need to say to get it.
Thank you for your response Blackwave - it is helpful. Could I ask if either of your children has been able to access any treatment as a result of their diagnosis or is that something that is then dealt with by the Gender Clinics?

Talk therapy + meds for associated (and more impactful) underlying conditions.

Hopefully DBT privately for the GD when I can afford to pay for it.

I did not ask for a referral to a gender clinic and would not have followed one up if it were offered.

I think the diagnosis is essentially meaningless. It describes a story the client tells the psychiatrist. What is more meaningful, imo, is underlying history/conditions - anxiety, depression, other mental health issues, family issues, trauma, autism, struggles with sexuality etc.

[BlackWaveComing]

[quote gardenbird48]**@SisterWendyBuckett* @Smallblanket @BlackWaveComing - thank you so much for your input - I am asking the further questions because I'm trying to work out what would usually be sensible with any case that involves medical treatment but worryingly from your responses so far it would seem that I am way off the mark and that effectively children can self-diagnose into major surgery and life changing hormone treatment (which I realise has been gone over before) but it is the apparent self diagnosis* element of it that is just hitting home for me - if it this the case then that is just unreal!!
No one is allowed to self-diagnose for any other condition that has medical implications ie. surgery - no one..[/quote]
Well...it's not that the kids give themselves the diagnosis. They immerse themselves in the narrative either consciously or unconsciously (which includes learning how to answer the questions a psychiatrist may ask in a way that leads to diagnosis in order to access the desired treatment and continue to live out the fantasy narrative). Once that's happened, the diagnosis happens very quickly, and treatment can follow, especially if the parents are very enthusiastic - although our most recent psychiatrist says she views parental happiness re transitioning as a red flag.

But....there are a lot of issues around diagnosis in psychiatry. It's not confined to this one issue. A diagnosis isn't scientific, in the way we might understand or expect it to be. It's the box that any given story best fits into at a given point in time. A diagnosis of GD doesn't tell us anything meaningful, really. It's just shorthand for a particular cluster of asserted experiences, which may or may not be accurate.

Re review/pausing/ceasing treatment, if started:

I think the best analogy is one around medical intervention in childbirth. There's a concept in birth studies - the cascade effect - where one intervention during birth makes another and then another more likely. It's how you might be more likely to go from an epidural to forceps to a major tear needing stitching than if you don't start with the epidural. (No birthing judgement attaches to this analogy, btw, a safe birth is a good birth).

It's pretty much the same with GD.

Social transitioning makes blockers more likely. Blockers make cross sex hormones more likely. The more the natural body is altered, the more likely it is that someone will seek out a double mastectomy or other surgeries.

The time to halt the risk of a cascade effect in adolescents is before social transition. Detransitioners are very poorly treated, and given we have no idea who will detransition, better to delay transition until well into adulthood.