Real-life experience (transgender)
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The Real-Life Experience (RLE), sometimes called the Real-Life Test (RLT), is a period of time in which transgender individuals live full-time in their preferred gender role, in order to demonstrate that they can function successfully as a member of said gender in society, as well as to be sure that they wish to live as said gender for the rest of their life. Documenting real-life experience is a requirement of some physicians before prescribing cross-sex hormone treatment, and a requirement of most surgeons before performing sex reassignment surgery.
Standards of Care
The sixth version of the World Professional Association for Transgender Health's (WPATH) Standards of Care (SOC), published in 2001 lists the parameters of the RLE as follows:
- To maintain full or part-time employment;
- To function as a student;
- To function in community-based volunteer activity;
- To undertake some combination of items 1-3;
- To acquire a (legal) gender-identity-appropriate first name;
- To provide documentation that persons other than the therapist know that the patient functions in the desired gender role.
The seventh version of the SOC, which was published in 2011 and is the most recent edition of the standards, is more ambiguous, and does not list any specific parameters for the RLE. Instead, they merely state that the individual should be living full-time in their preferred gender role continuously for the duration of the RLE. They do also state that documentation of a name and/or gender marker change can be presented as a way of providing proof that the RLE has been completed, but they do not state that a name and/or gender marker change is actually a necessary requirement for completion of the RLE. Taken together, these changes may be some of WPATH's ways of moving away from the encouragement of "gatekeeping," which the SOC have been greatly scrutinized as well as criticized for in the past.
The SOC are followed by most, if not the vast majority, of medical professionals who specialize in the care of transgender individuals, and are the most widely followed clinical guidelines for the treatment of transgender persons in use. Hence, the SOC criteria for hormone therapy and surgery, including completion of an RLE when applicable, must usually be met for one who seeks such treatments to receive them.
As of the seventh version of the SOC, a three-month minimum requirement of RLE is no longer part of WPATH's recommended criteria for hormone therapy. A referral letter alone from a qualified mental health professional now suffices. The SOC state:
Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's responsibility.
With respect to mastectomy and chest reconstruction in female-to-male individuals and breast augmentation in male-to-females, the seventh version of the SOC do not require an RLE for these procedures. Nor is an RLE required for many other procedures such as facial feminization surgery. However, for genital surgery, including hysterectomy/oophorectomy, orchiectomy, metoidioplasty, phalloplasty, and vaginoplasty, 12 months of continuous RLE is listed as a requirement.
Previous versions of the SOC stated that an RLE for genital surgery was an absolute requirement that could not be skipped or ignored. However, the seventh version of the SOC appears to be less stringent, and does not state anything of the sort. In addition, WPATH emphasizes that the SOC are merely clinical guidelines, and that they are intended to be both flexible and modifiable to meet the circumstances of the patient and the preferences and judgement of the clinician. Hence, the latest version of the SOC potentially allow for the RLE to be completely skipped.
Clinical practice in many places may be more or less stringent. In the United Kingdom, most National Health Service trusts will require 24 months of RLE before surgery, whereas in countries such as Thailand and Mexico, many surgeons do not require the completion of any RLE at all.
Proof of completion
The seventh version of the SOC state that medical professionals should clearly document a patient's RLE in their medical chart, including the start date of living full-time for those preparing for genital surgery. Sometimes surgeons may require proof that the RLE has been completed. The SOC state that, if applicable, proof may be provided in the form of communication with individuals who have related to the patient in a gender identity-congruent role (such as, presumably, the patient's physician or therapist, boss, or one of their teachers), or as documentation of a legal name and/or gender marker change.
- Transitioning (transgender)
- Hormone replacement therapy (transgender)
- Sex reassignment surgery
- List of transgender-related topics
- Harry Benjamin International Gender Dysphoria Association (January–March 2001). "Standards of Care for Gender Identity Disorders, Sixth Version". International Journal of Transgenderism 5 (1).
- World Professional Association for Transgender Health (September 2011), Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Seventh Version
- Peggy J. J. Kleinplatz (23 April 2012). New Directions in Sex Therapy: Innovations and Alternatives. CRC Press. pp. 666–667. ISBN 978-1-136-33332-3. Retrieved 8 September 2012.
- Jack Drescher; Dan Karasic (5 September 2006). Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation. Psychology Press. pp. 54–55. ISBN 978-0-7890-3214-0. Retrieved 8 September 2012.
- Julia Serano (20 May 2009). Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity. Seal Press. pp. 116, 119–126. ISBN 978-0-7867-4791-7. Retrieved 8 September 2012.
- Jacques, Juliet (23 January 2012). "A Transgender Journey: Are You Experienced?". The Guardian. Retrieved 8 September 2012.